1/43. Intracerebral pneumatocele: an unusual complication following intraventricular drainage in case of benign intracranial hypertension.The development of an intracerebral pneumatocele following ventricular catheterization for benign intracranial hypertension is described. The importance of skull radiography in the diagnosis of this previously unreported complication ist emphasized. This case demonstrates that air can accumulate without the need to implicate increased pharyngeal pressure, and despite raised intracranial pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/43. Atraumatic pneumocephalus: a case report and review of the literature.pneumocephalus or air within the cranial vault is usually associated with disruption of the skull caused by head trauma, neoplasms, or after craniofacial surgical interventions. We report a child who presented with headache and the pathognomonic "succussion splash" and was found to have atraumatic pneumocephalus from forceful valsalva maneuvers. pneumocephalus forms, caused by either a ball-valve mechanism that allows air to enter but not exit the cranial vault, or cerebrospinal fluid (CSF) leaks, which create a negative pressure with subsequent air entry. We review the literature for traumatic and atraumatic causes of pneumocephalus, its complications, and therapy.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/43. frontal sinus pneumocele. A case report.A pneumocele refers to an aerated sinus with either focal or generalized thinning of the bony sinus wall. Although the pathogenesis of a pneumocele is not yet known, it is presumed that increased intrasinusal pressure, due to a one-way valve between the nasal cavity and the affected sinus, is responsible for this condition. A 37-year-old man with frontal bossing, who underwent surgery for cosmetic reasons, is presented.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/43. Extensive and symptomatic cranial pneumatization: caused by frequent performance of Valsalva's manoeuvre?Pneumocranium and spontaneous pneumocephalus are very rare disorders. We report a case in which the patient had suffered for some time from neck pain and neurological symptoms which originated from an extensively pneumatized cranium. The symptoms and the abnormal bone pneumatization disappeared after normalization of a high middle-ear pressure. The history and the findings suggest that the pathological pneumatization was caused by the patient's habit of frequently performing Valsalva's manoeuvre, in combination with the eustachian tube functioning as a valve.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/43. An unusual fatal complication of low basilar trunk aneurysm surgery: isolated prepontine tension pneumocephalus.OBJECTIVE: A case of postoperative tension pneumocephalus after low basilar trunk aneurysm clipping is presented. To our knowledge, this is the first case of isolated prepontine tension pneumocephalus. BACKGROUND: A 63-year-old woman was admitted for repair of a basilar aneurysm that had caused a subarachnoid hemorrhage. She was cooperative and partially oriented. According to Hunt & Hess classification, she was considered Grade III. METHOD: The aneurysm was clipped, using a right lateral suboccipital craniectomy with the patient in the sitting position. In the early postoperative period, she had no new neurological deficit. However, 2 hours later the patient became lethargic and unresponsive to verbal commands. Emergency CT scan revealed an isolated prepontine tension pneumocephalus with prominent posterior displacement of the pons. She was immediately taken back to surgery. Upon incision of the dura mater, air could be heard escaping under pressure from the posterior fossa cavity. The clip was in its proper position and all arteries were patent. Spontaneous respiration and pupil reflexes returned soon after surgery, but she remained unconscious and died 3 days later. CONCLUSION: We believe that this death was directly attributable to the tension pneumocephalus and the distortion of the pons. Postoperative prepontine tension pneumocephalus, although this is an extremely rare condition, should be considered if a patient deteriorates after basilar aneurysm surgery in the sitting position.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/43. Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo Clinic experience 1976-1998.We describe four cases of symptomatic pneumocranium, a rare, potentially life-threatening complication of transsphenoidal pituitary surgery. Symptomatic pneumocranium manifested as impaired mental status, headaches, and grand mal seizures, early in the postoperative course after transsphenoidal pituitary surgery. Furthermore, a Cushing response, including systemic hypertension and bradycardia (secondary to intracranial hypertension) was seen, which has not been previously described in association with symptomatic pneumocranium. We describe a previously unreported risk factor for tension pneumocranium, untreated obstructive sleep apnea. Other factors predisposing to tension pneumocranium in our patients included: cerebrospinal fluid leaks, postoperative positive-pressure mask ventilation, large pituitary tumors, and intraoperative lumbar drainage catheters. Surgical drainage of the pneumocranium and repair of any coexistent cerebrospinal fluid leak markedly improved neurologic status. Symptomatic pneumocranium occurring early in the postoperative course after transsphenoidal pituitary surgery is rare, but prompt recognition and treatment of this condition can be life-saving.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/43. Fatal posterior fossa pneumocephalus due to hydrogen peroxide irrigation of lumbar wound.Fatal brain stem failure developed suddenly in a 40-year-old male undergoing irrigation of an infected wound consequent to lumbar disc space infection. CT of head revealed posterior fossa pneumacephalus compressing the brain stem, which most likely developed from ingress of nascent oxygen under pressure through a defect in the thecal sac.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/43. pneumocephalus following ventriculoperitoneal shunt. Case report.The authors describe a case of massive pneumocephalus following ventriculoperitoneal shunting for hydrocephalus. After multiple diagnostic and surgical procedures, congenital defects in the tegmen tympani of both temporal bones were identified as the sources for entry of air. A functioning shunt intermittently established negative intracranial pressure and allowed ingress of air through these abnormalities; when the shunt was occluded, air did not enter the skull, and there was no cerebrospinal fluid leakage. Repair of these middle ear defects prevented further recurrence of pneumocephalus.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/43. Disseminated pneumocephalus secondary to an unusual facial trauma.pneumocephalus can be secondary to a postintrathecal procedure, sinus fracture, basilar skull fracture, congenital skull defect, neoplasm, gas producing organism, barotrauma, neurosurgery, paranasal sinus surgery, mask or nasal continuous positive-airway pressure. Unusual facial traumas can also be rare causes of pneumocephalus. Here, we present such a case in whom an air compressor tip injury to both eyes led to the disseminated pneumocephalus. We report this rare case with the computed tomography findings and try to explain the possible mechanism of the pnemocephalus.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/43. Tension pneumocyst after transsphenoidal surgery for Rathke's cleft cyst: case report.OBJECTIVE AND IMPORTANCE: Tension pneumocephalus is a rare but well-described complication of transsphenoidal surgery. It is usually associated with postoperative cerebrospinal fluid fistulae causing lower intracranial pressure, with air located in the subdural, subarachnoid, or intraventricular space. We report a case of suprasellar tension pneumocyst that caused visual deterioration to develop after an operation for a Rathke's cleft cyst. Only one similar case has been reported previously. CLINICAL PRESENTATION: A 54-year-old woman with a cystic sellar-suprasellar mass compressing the chiasm was operated on via a standard transsphenoidal approach. The intraoperative diagnosis was Rathke's cleft cyst, and the floor of sella was left open to avoid recurrence. The sphenoid sinus was filled with a fat graft, and the rostrum of the sphenoid was reconstructed with a bone fragment. The patient's postoperative course was uneventful, and her vision improved. Ten days after discharge, the patient was readmitted to the emergency service with headache and visual impairment. Emergent computed tomography confirmed a suprasellar tension pneumocyst. INTERVENTION: The patient underwent immediate reoperation via an endonasal endoscopic approach. After the trapped air was evacuated, the sella was closed with fascia lata and muscle using fibrin glue. The patient's vision improved postoperatively. CONCLUSION: Suprasellar tension pneumocyst is an extremely rare complication of transsphenoidal surgery. To avoid this complication, the sellar floor should be repaired in a watertight fashion, and patients should be instructed to avoid blowing the nose, sneezing, straining, and coughing postoperatively.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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