Pneumocephalus: case illustrations and review.
Pneumocephalus is commonly encountered after neurosurgical procedures but can also be caused by craniofacial trauma and tumors of the skull base and rarely, can occur spontaneously. Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N(2)O) anesthesia, hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous CSF drainage via lumbar drain, epidural anesthesia, infections, and neoplasms. Clinical presentation includes headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status. In this article, we review the incidence, mechanisms, precipitating factors, diagnosis, and management of pneumocephalus. Search of Medline, databases, and manual review of article bibliographies. Considering four case illustrations that typify pneumocephalus in clinical practice, we discuss the common etiologies, and confirm the diagnosis with neuroimaging and management strategies. Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity. A significant amount of pneumocephalus can simulate a space-occupying lesion. Supplemental oxygen increases the rate of absorption of pneumocephalus.
Schirmer
Clemens M
CM
Department of Neurological Surgery, Tufts University School of Medicine, Boston, MA 02111, USA.
Heilman
Carl B
CB
Bhardwaj
Anish
A
D000236:Adenoma / Q000601:surgery; D000273:Adipose Tissue / Q000637:transplantation; D000368:Aged; D001139:Arnold-Chiari Malformation / Q000000981:diagnostic imaging / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002908:Chronic Disease; D003937:Diagnosis, Differential; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000601:surgery; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
Anaesthesia. 1982 Oct;37(10):996-1001
7137555
Pediatr Infect Dis J. 2008 Dec;27(12):1118-9
19068520
Anesthesiology. 1982 Jul;57(1):59-61
7091725
Pediatrics. 2006 Nov;118(5):e1576-9
17000783
J Neurosurg. 1998 Dec;89(6):1036-9
9833834
J Neurosurg. 1976 Mar;44(3):383-5
1249619
Anesthesiology. 1982 Jan;56(1):73-5
7053678
Neurosurgery. 1979 Mar;4(3):261-3
460560
Neurosurgery. 1983 Feb;12(2):164-8
6835498
Anesth Analg. 1981 Jan;60(1):57-8
7192950
Arch Neurol. 2009 Sep;66(9):1172-3
19752312
J Laryngol Otol. 1984 May;98(5):543-5
6715989
Am J Otolaryngol. 2010 Jul-Aug;31(4):226-30
20015750
Anesth Analg. 2004 Feb;98(2):524-526
14742399
Acta Neurochir (Wien). 1967;16(1):1-78
6032371
Anesthesiology. 1985 May;62(5):690-2
3994045
JAMA. 1986 Jun 13;255(22):3154-6
3702028
Neurosurgery. 1979 Sep;5(3):368-70
503299
J Neurosurg. 1988 Jan;68(1):58-61
3335913
Anaesthesia. 1982 Jul;37(7):722-5
7201753
J Neurosurg Anesthesiol. 2007 Jul;19(3):161-5
17592346
J Neurosurg. 1979 Apr;50(4):525-7
423011
Anesthesiology. 1994 May;80(5):1008-12
8017640
J Neurosurg. 2008 May;108(5):926-9
18447708
Anesthesiology. 1983 Feb;58(2):196-7
6824179
Am J Rhinol. 2000 Jul-Aug;14(4):257-9
10979500
J Neurosurg. 1975 Nov;43(5):631-3
1181396
J Neurosurg. 2004 Aug;101(2):340-2
15309929
Neurosurgery. 1985 Jan;16(1):107-10
3974807
J Neurosurg. 1984 Jun;60(6):1312-4
6726378
Neurocirugia (Astur). 2003 Jun;14(3):216-21
12872170
Acta Neurochir (Wien). 1986;83(3-4):112-5
3812035
Anesthesiology. 1976 May;44(5):448-50
1267216
Anesthesiology. 1992 Sep;77(3):421-5
1519779
Neurosurgery. 2002 Apr;50(4):878-9; discussion 880
11904043
Br J Neurosurg. 1990;4(5):381-5
2261099
J Neurosurg. 2004 Nov;101(5):757-61
15540912
AJNR Am J Neuroradiol. 1995 Mar;16(3):487-90
7793370
Anesthesiology. 1996 Feb;84(2):442-7
8602677
Can J Neurol Sci. 1998 Feb;25(1):79-81
9532287
Neurosurgery. 1984 Jun;14(6):649-58
6462398
Anesth Analg. 1986 Jan;65(1):65-70
3455673