1/25. pneumocephalus associated with aqueductal stenosis: three-dimensional computed tomographic demonstration of skull-base defects.Ventriculoperitoneal (VP) shunt placement in patients with aqueductal stenosis has recently been reported as a cause of pneumocephalus. We report on a patient with pneumocephalus associated with aqueductal stenosis treated by VP shunting. A 29-year-old woman who had undergone a shunt operation for aqueductal stenosis 7 years previously sustained a whiplash injury in a minor traffic accident. Computed tomography (CT) revealed massive subdural pneumocephalus, and three-dimensional reconstructions of CT images clearly demonstrated defects in the skull base overlying the ethmoid sinuses. Both endoscopic III ventriculostomy and placement of external ventricular drainage were came free of symptoms and rhinorrhea ceased. Three-dimensionally reconstructed CT images were useful in detecting the extent of the patient's skull base defect. III ventriculostomy was not effective in this case. Direct closure of the skull base by craniotomy was not necessary, and a programmable valve system was effective in preventing recurrence of either pneumocephalus or rhinorrhea.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
2/25. 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 = 3keywords = subdural (Clic here for more details about this article) |
3/25. Subdural and intraventricular traumatic tension pneumocephalus: case report.Simple pneumocephalus most frequently arises as a complication of a head injury in which a compound basal skull fracture with tearing of the meninges allows entry of air into the cranial cavity. It can also follow a neurosurgical operation. Tension traumatic pneumocephalus with intraventricular extension is an extremely rare, potentially lethal condition that requires prompt diagnosis and treatment. We report the case of subdural and intraventricular accidental tension pneumocephalus occurring in a 26-year-old man as a result of skull fracture. This case is combined with rhinorrhea and meningitis that suggest some difficulties to treat. The operative procedure associated with medical treatment was performed and a good result was obtained.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
4/25. Chronic subdural hematoma after transsphenoidal surgery.Chronic subdural haematoma has not been reported as a complication of transsphenoidal surgery. We present a case of pituitary adenoma which was gross-totally removed by transsphenoidal surgery with the enlarged sellar opening. Postoperative serial imaging showed massive air accumulation in both frontal subdural spaces followed by subdural fluid collection and subsequent chronic subdural haematomas 2 months later. We conclude that close follow up imaging study is required to avoid overlooking chronic subdural haematoma when massive air is introduced into the subdural space by the transsphenoidal surgery.- - - - - - - - - - ranking = 10.947864962635keywords = subdural, subdural haematoma, haematoma (Clic here for more details about this article) |
5/25. pneumocephalus. A sign of intracranial involvement in orbital fracture.Fractures of the orbit resulting from blunt or penetrating injury that involve the paranasal sinuses may tear the dura and allow air to enter the cranial cavity (pneumocephalus). pneumocephalus is sometimes the only sign of intracranial involvement. It is characteristically delayed in onset and clinically unsuspected, so that routine follow-up roentgenograms of patients with orbitosinus fractures may be the only means of assuring early detection. Roentgenographically, the air may be seen in spidural, subdural subarachnoid, intracerebral, or intraventricular locations. Prophylactic parenterally administered antibiotics may prevent intracranial infection. However, since about 25% of patients still develop meningitis, surgical repair of the dural fistula is often necessary.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
6/25. Pneumatization of the intraorbital optic nerve after severe head trauma.Radiological evidence of pneumatization of the intraorbital optic nerve sheath following severe head trauma in an adult is reported. A young man was admitted to the emergency department following a high-speed motorcycle accident with unconsciousness, forehead laceration, and multiple fractures of the skull and extremities. On admission, the pupils were dilated and fixed. Computed tomography revealed right subdural hematoma with midline shift, brain stem hemorrhage, contusion of the left temporal lobe, multiple facial bone fractures, cerebral edema with intracerebral air, and meningeal pneumatization of the optic nerve sheaths bilaterally. This case demonstrates that after severe head trauma, air may extend in the optic nerve sheath, which could be a marker of severe optic nerve injury.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
7/25. 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 = 1keywords = subdural (Clic here for more details about this article) |
8/25. headache from intracranial air after a lumbar epidural injection: subarachnoid or subdural?BACKGROUND AND methods. There is a growing awareness of the possibility of headache resulting from intracranial air secondary to identification of the epidural space by loss of resistance using air (LOR-A). Most reported cases have been attributed to subarachnoid air passage. A case is described of sudden headache following LOR-A. RESULTS. Various features of the case suggest that the passage of air to the head was subdural rather than subarachnoid. CONCLUSIONS. Recovery was uneventful.- - - - - - - - - - ranking = 5keywords = subdural (Clic here for more details about this article) |
9/25. Intracerebral pneumocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma. Case report.A halo orthosis is often used to immobilize the cervical spine after severe injury in patients who cannot tolerate surgery. Although complications such as pin loosening or brain abscess have been reported, there are no reported cases of hemiparesis following pneumocephalus associated with halo use. The authors report the case of a 77-year-old man with multiple myeloma who, after undergoing halo vest therapy and chemotherapy, suddenly developed hemiparesis and speech disturbance. Diagnostic neuroimaging demonstrated penetration of the inner table at the right posterior pin site and intracerebral pneumocephalus at the parietal lobe. Intraoperative inspection revealed only air and no purulent materials or cerebrospinal fluid in the cystic lesion. When a halo device is used, attention to detail in pin application, maintenance, and proper pin-site care must be undertaken to minimize complications. The tightening of the pin in cases in which late-onset loosening has occurred should not be performed. Additionally, because late loosening of the pin and pin-site infection increase the risks of complications, a halo vest should be used only as a short-term treatment, and the clinician should be aware of the possible increased risk of serious complications such as pneumocephalus or subdural abscess formation.- - - - - - - - - - ranking = 1keywords = subdural (Clic here for more details about this article) |
10/25. Spontaneous acute subdural haematoma caused by tension pneumocephalus.We describe the first case of spontaneous acute subdural haematoma (SASH) caused by tension pneumocephalus in a patient who had undergone surgery for sinusitis followed by meningitis many years previously. The patient presented with a seizure and epistaxis. The haematoma was caused by a torn bridging vein. Tension pneumocephalus has to be added to the list of possible causes for SASH.- - - - - - - - - - ranking = 6.6061741252134keywords = subdural, subdural haematoma, haematoma (Clic here for more details about this article) |
| | Next -> |