title: Pneumocephalus: case illustrations and review.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Schirmer
authors.forename: Carl B
authors.initials: CB
authors.lastname: Heilman
authors.forename: Anish
authors.initials: A
authors.lastname: Bhardwaj
mesh_terms: 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
references.citation: Anaesthesia. 1982 Oct;37(10):996-1001
references.pmid: 7137555
references.citation: Pediatr Infect Dis J. 2008 Dec;27(12):1118-9
references.pmid: 19068520
references.citation: Anesthesiology. 1982 Jul;57(1):59-61
references.pmid: 7091725
references.citation: Pediatrics. 2006 Nov;118(5):e1576-9
references.pmid: 17000783
references.citation: J Neurosurg. 1998 Dec;89(6):1036-9
references.pmid: 9833834
references.citation: J Neurosurg. 1976 Mar;44(3):383-5
references.pmid: 1249619
references.citation: Anesthesiology. 1982 Jan;56(1):73-5
references.pmid: 7053678
references.citation: Neurosurgery. 1979 Mar;4(3):261-3
references.pmid: 460560
references.citation: Neurosurgery. 1983 Feb;12(2):164-8
references.pmid: 6835498
references.citation: Anesth Analg. 1981 Jan;60(1):57-8
references.pmid: 7192950
references.citation: Arch Neurol. 2009 Sep;66(9):1172-3
references.pmid: 19752312
references.citation: J Laryngol Otol. 1984 May;98(5):543-5
references.pmid: 6715989
references.citation: Am J Otolaryngol. 2010 Jul-Aug;31(4):226-30
references.pmid: 20015750
references.citation: Anesth Analg. 2004 Feb;98(2):524-526
references.pmid: 14742399
references.citation: Acta Neurochir (Wien). 1967;16(1):1-78
references.pmid: 6032371
references.citation: Anesthesiology. 1985 May;62(5):690-2
references.pmid: 3994045
references.citation: JAMA. 1986 Jun 13;255(22):3154-6
references.pmid: 3702028
references.citation: Neurosurgery. 1979 Sep;5(3):368-70
references.pmid: 503299
references.citation: J Neurosurg. 1988 Jan;68(1):58-61
references.pmid: 3335913
references.citation: Anaesthesia. 1982 Jul;37(7):722-5
references.pmid: 7201753
references.citation: J Neurosurg Anesthesiol. 2007 Jul;19(3):161-5
references.pmid: 17592346
references.citation: J Neurosurg. 1979 Apr;50(4):525-7
references.pmid: 423011
references.citation: Anesthesiology. 1994 May;80(5):1008-12
references.pmid: 8017640
references.citation: J Neurosurg. 2008 May;108(5):926-9
references.pmid: 18447708
references.citation: Anesthesiology. 1983 Feb;58(2):196-7
references.pmid: 6824179
references.citation: Am J Rhinol. 2000 Jul-Aug;14(4):257-9
references.pmid: 10979500
references.citation: J Neurosurg. 1975 Nov;43(5):631-3
references.pmid: 1181396
references.citation: J Neurosurg. 2004 Aug;101(2):340-2
references.pmid: 15309929
references.citation: Neurosurgery. 1985 Jan;16(1):107-10
references.pmid: 3974807
references.citation: J Neurosurg. 1984 Jun;60(6):1312-4
references.pmid: 6726378
references.citation: Neurocirugia (Astur). 2003 Jun;14(3):216-21
references.pmid: 12872170
references.citation: Acta Neurochir (Wien). 1986;83(3-4):112-5
references.pmid: 3812035
references.citation: Anesthesiology. 1976 May;44(5):448-50
references.pmid: 1267216
references.citation: Anesthesiology. 1992 Sep;77(3):421-5
references.pmid: 1519779
references.citation: Neurosurgery. 2002 Apr;50(4):878-9; discussion 880
references.pmid: 11904043
references.citation: Br J Neurosurg. 1990;4(5):381-5
references.pmid: 2261099
references.citation: J Neurosurg. 2004 Nov;101(5):757-61
references.pmid: 15540912
references.citation: AJNR Am J Neuroradiol. 1995 Mar;16(3):487-90
references.pmid: 7793370
references.citation: Anesthesiology. 1996 Feb;84(2):442-7
references.pmid: 8602677
references.citation: Can J Neurol Sci. 1998 Feb;25(1):79-81
references.pmid: 9532287
references.citation: Neurosurgery. 1984 Jun;14(6):649-58
references.pmid: 6462398
references.citation: Anesth Analg. 1986 Jan;65(1):65-70
references.pmid: 3455673