1/79. temporal bone fracture following blunt trauma caused by a flying fish.Blunt trauma to the temporal region can cause fracture of the skull base, loss of hearing, vestibular symptoms and otorrhoea. The most common causes of blunt trauma to the ear and surrounding area are motor vehicle accidents, violent encounters, and sports-related accidents. We present an obscure case of a man who was struck in the ear by a flying fish while wading in the sea with resulting temporal bone fracture, sudden deafness, vertigo, cerebrospinal fluid otorrhoea, and pneumocephalus.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/79. 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 = 1keywords = spinal (Clic here for more details about this article) |
3/79. pneumocephalus following inadvertent intrathecal puncture during epidural anesthesia: a case report and review of the literature.Regional anesthesia techniques (epidural and spinal) are preferred anesthetic modalities in modern obstetrics, in that both of these modalities enable maternal participation in the delivery process and assist in avoiding maternal aspiration associated with general anesthesia. We report an unusual and potentially severe complication of epidural anesthesia for elective repeat cesarean delivery. Following intravenous hydration and lateral uterine displacement, uneventful epidural anesthesia was administered. Toward the end of the otherwise uneventful cesarean the patient, who had been completely stable, became unresponsive, with dilated pupils that did not respond to light. The patient was immediately intubated and gradually regained consciousness and was extubated within 1 h. Cranial computed tomography disclosed pneumocephalus. Inadvertent pneumocephalus is reviewed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
4/79. 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 = 2keywords = spinal (Clic here for more details about this article) |
5/79. Spontaneous pneumocephalus in the posterior fossa in a patient with a ventriculoperitoneal shunt: case report.OBJECTIVE AND IMPORTANCE: A unique case of spontaneous pneumocephalus is described. It appeared a few years after the uneventful introduction of a cerebrospinal fluid shunt and was probably attributable to a defect of the posterior mastoid plate. CLINICAL PRESENTATION: A 65-year-old man presented with a subacute onset of vertigo, vomiting, and atactic gait instability. The patient had undergone a ventriculoperitoneal shunt implantation 2 years previously for communicating hydrocephalus. A computed tomographic scan revealed a posterior fossa pneumatocele without hydrocephalus. INTERVENTION: A simple mastoidectomy was performed. Detection of the area of the bone defect was followed by mastoid obliteration with abdominal fat. CONCLUSION: Clinicians should be aware that pneumocephalus can occur spontaneously, with or without obvious shunt problems. Treatment should be directed toward the area through which air penetrated the posterior fossa.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
6/79. Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula.A case of tension pneumocephalus and pneumorachis secondary to a subarachnoid pleural fistula after thoracic spinal surgery is described. This rare complication was diagnosed on CT. The imaging findings, significance and management of this unusual condition are discussed.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
7/79. Gas in the cranium: an unusual case of delayed pneumocephalus following craniotomy.We present the case history of a 23-year-old man who underwent frontal craniotomy followed by radiotherapy for a Grade III anaplastic glioma. magnetic resonance imaging (MRI) at the 3-month follow-up showed significant tumour response. He became unwell some weeks after the MRI with an upper respiratory tract infection, severe headache and mild right-sided weakness. A computed tomographic (CT) scan showed a very large volume of intracranial gas, thought to have entered via a defect in the frontal air sinus after craniotomy and brought to light by blowing his nose. Intracranial air is frequently present after craniotomy, but it is normally absorbed within 34 weeks. The presence of pneumocephalus on a delayed postoperative CT scan should raise the possibility of a cerebrospinal fluid (CSF) fistula, or infection with a gas-forming organism. Many CSF fistulae require surgical closure in order to prevent potentially life-threatening central nervous system infection and tension pneumocephalitis. Immediate neurosurgical review is advisable.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
8/79. Endoscopic endonasal surgery (EES) in skull base repairs and CSF leakage.This report aims to summarise the current role of Endoscopic Endonasal Surgery (EES) for skull base and cerebrospinal fluid (CSF) leakage repair, to provide some guidelines for the clinical diagnosis and technical procedures of repair, to demonstrate the limits of this approach and to discuss the Belgian experience of the recent years. Endoscopic surgery for chronic sinus disease is being performed with increasing frequency and CSF leak is an significant potential complication of this surgery, although the incidence of osteo-meningeal perforations in endonasal sinus surgery is below 1% overall. CSF leakage bears the risk of meningeal or intracranial infection and complication and therefore should be repaired as soon as recognised. Following proper localisation of the leak, repair is safely performed in most of the cases by endonasal route with the help of free mucoperiostal flaps taken from the inferior or middle turbinates. This also applies for lesions of other aetiologies. The Belgian data support the statement that the endonasal endoscopic approach is a suitable and successful technique to close CSF leaks in the vast majority of our patients.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/79. Subdural air limits the elicitation of compound muscle action potentials by high-frequency transcranial electrical stimulation.High-frequency transcranial electrical stimulation was performed in 8 patients undergoing surgery in the sitting position. Following the opening of the dura of the posterior fossa changes in compound muscle action potentials were observed. These changes were not attributable to surgical manoeuvres at the brain stem or spinal cord, or to anaesthetic changes. In all these cases intraoperative fluoroscopy of the skull revealed a subdural air collection underneath the stimulation electrodes. Such a subdural air collection, not infrequent in patients operated on in the sitting position, limits the application of high-frequency transcranial electrical stimulation as a monitoring technique. It remains unclear if this effect is due to the increasing distance between scalp and cortex and the insulating effect of subdural air, or due to displacement of the motor cortex. The practical importance of this report is derived from the increasing application of intraoperative motor pathway monitoring.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
10/79. Massive pneumocephalus following Merocel nasal tamponade for epistaxis.Anterior epistaxis is commonly treated with Merocel nasal tampon insertion in preference to gauze packing. An 89-year-old patient was found to have cerebrospinal fluid rhinorrhea and massive pneumocephalus immediately after removal of a Merocel tampon used for spontaneous anterior epistaxis. She later developed fever and mild confusion, but was well at three-month follow-up. The advantages and complications of Merocel nasal tamponade are briefly reviewed and compared with those of other methods of control of anterior epistaxis.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
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