title: Symptomatic compressive pneumocephalus following lumbar decompression surgery.
abstract: We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France. Electronic address: gautheremi@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Gauthé
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Latrobe
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Damade
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Foulongne
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Roussignol
authors.affiliation: Department of Orthopedic Surgery, Spine Unit, Charles-Nicolle University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Ould-Slimane
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology*; D013130:Spinal Stenosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Dural tear; Laminectomy; Lumbar decompression; Pneumocephalus; Pneumorachis; Spinal surgery