Gader G, Rkhami M, Daghfous A, Zouaghi M, Zammel I, Badri M. Pneumocephalus after posterior fossa surgery in prone position: Is that any clinical effect?
Int J Surg Case Rep 2021;
90:106736. [PMID:
34968981 PMCID:
PMC8717224 DOI:
10.1016/j.ijscr.2021.106736]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction
The term pneumocephalus refers to the existence of air in any intracranial compartment. Its presence in the follows of a supratentorial craniotomy is very common, and it usually represents a benign complication as it is very rarely responsible for clinical manifestations.
Case presentation
We report the case of a 24 years-old man, who underwent posterior fossa surgery in prone position for resection of a vermian tumor. Postoperative, the patient presented a tonic-clonic generalized seizure associated to high levels of arterial pressure and decerebration. Control CT scan showed an important pneumocephalus. On the posterior fossa, the air was responsible for a compression of the brainstem, without any other postoperative complications. Following 12 h of conservative management, a brain MRI showed a total regression of the pneumocephalus. 3 days later, the patient presented a favorable outcome as he was extubated without any major impairments.
Discussion
Transformation of pneumocephalus into tension pneumocephalus responsible for clinical inadvertance is rare. This complication is mainly related to surgeries performed in sitting position. The occurrence of compressive pneumocephalus after a posterior fossa craniotomy performed in a prone position is seldom.
Conclusions
Through this case, we discuss pathophysiology and therapeutic approaches for tension pneumocephalus following posterior fossa performed in prone position.
Pneumocephalus may be source for major postoperative inadvertance
Tension pneumocephalus was reported in supratentorial surgeries. Posterior fossa craniotomies may also lead to this inadvertence.
Rigorous peroperative prevention of pneumocephalus should be considered in order to minimize complications.
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