Gore PA, Maan H, Chang S, et al. Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus

Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 06/2008; 108(5):926-9. DOI: 10.3171/JNS/2008/108/5/0926
Source: PubMed


Postsurgical pneumocephalus is an unavoidable sequela of craniotomy. Sufficiently large volumes of intracranial air can cause headaches, lethargy, and neurological deficits. Supplemental O(2) to increase the rate of absorption of intracranial air is a common but unsubstantiated neurosurgical practice. To the authors' knowledge, this is the first prospective study to examine the efficacy of this therapy and its effect on the rate of pneumocephalus absorption.
Thirteen patients with postoperative pneumocephalus that was estimated to be > or = 30 ml were alternately assigned to breathe 100% O(2) using a nonrebreather mask (treatment group) or to breathe room air (control group) for 24 hours. Head computed tomography (CT) scans without contrast enhancement were obtained at the beginning and end of treatment or control therapy. A neuroradiologist blinded to the type of treatment used software to calculate the 3D volume of the pneumocephalus from the CT scans. The percentage of pneumocephalus absorption was calculated for each study participant.
There was no statistically significant difference between the treatment and control groups regarding the mean initial pneumocephalus volume or time interval between CT scans. There was a significant difference (p = 0.009) between the mean rate of pneumocephalus volume reduction in the treatment (65%) and control groups (31%) per 24 hours. No patient suffered adverse effects related to treatment.
Administration of postsurgical supplemental O(2) through a nonrebreather mask significantly increases the absorption rate of postcraniotomy pneumocephalus as compared with breathing room air.

550 Reads
  • Source
    • "Treatment of pneumocephalus in our institution involves continuous supplemental 100% oxygen by a nonrebreather mask. The increased oxygen tension in the bloodstream has previously been shown to more rapidly clear the volume of pneumocephalus in case reports and small studies [14, 15]. However, increasing the inspired oxygen beyond 40% may only provide marginal increases in the rate of absorption [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Symptomatic pneumocephalus is a rare complication of degenerative lumbar spine surgery. This is a case report of a patient who developed transient diplopia associated with pneumocephalus following lumbar spine surgery complicated by a dural tear. The diplopia improved as the pneumocephalus resolved. Factors involved in the development of pneumocephalus include an unintended durotomy and intraoperative reverse Trendelenburg positioning that was utilized to decrease the risk of postoperative vision loss. When encountering cerebrospinal fluid (CSF) leakage intraoperatively, spine surgeons should level the operating table until closure of the dural defect to prevent potential complications associated with pneumocephalus. If postoperative patients complain of severe headaches or display a focal cranial neurologic deficit, then a computed tomography (CT) scan of the brain should be ordered and evaluated. Consulting neurologists should be aware of the circumstances surrounding this rare complication.
    12/2013; 2013:792168. DOI:10.1155/2013/792168
    • "These include; endolumbar infusion of isotonic saline, ringer's solution or air during surgery, hyperhydratation of the patient, trendelenburg positioning of the patient with lowering of the head 30° horizontally and bed rest for up to a week, the replacement of the hematoma with carbon dioxide gas or oxygen, craniotomy without closure of the dura or replacing the bone plate, or an implant of a subcutaneous reservoir with a catheter introduced into the subdural cavity.[171826–31] The treatment of pneumocephalus with supplemental breathing of 100% O2 had been demonstrated to be effective.[4632] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pneumocephalus is commonly encountered after surgical evacuation of chronic subdural hematoma (CSDH). This study was done to study the incidence, clinical presentation, and management of patients who developed pneumocephalus after surgical evacuation of CSDH. This prospective study was carried out on consecutive 50 patients who had received surgical treatment for CSDH. All the patients included were followed-up postoperatively with regular clinical and computed tomography (CT) examinations immediately postoperatively, before discharge, and 2 months after surgery. Pneumocephalus was classified into simple and tension, based upon the clinical and radiological criteria. The neurologic grading system of Markwalder et al was used to evaluate the surgical results. The immediate postoperative CT scan showed pneumocephalus in 22 patients (44%). Tension pneumocephalus was found in two patients who did not require any further surgery. There was statistically significant increase in the incidence of pneumocephalus (immediate and postoperative) in the patients aged over 60 years as well as those presenting with a midline shift more than 5 mm in their CT scan. With regard to the 22 cases of pneumocephalus, good postoperative results were found in 16 patients (73%), while bad results were found in 6 patients (27%). No statistically significant difference in the outcome between patients who had pneumocephalus after surgery and those who had not. Pneumocephalus after surgical evacuation of CSDH is a common finding in the immediate CT scan as well as at time of discharge. Tension pneumocephalus may not require surgical intervention and simple aspiration of air using a syringe may be sufficient.
    04/2012; 7(2):66-74. DOI:10.4103/1793-5482.98647
  • Source
    • "Additional therapeutic recommendations include laxative use to decrease intra-abdominal pressure during bowel movements and supplemental oxygen therapy to hasten the absorption of pneumocephalus (vs. air).16 Although clinicians have prescribed hyperbaric oxygen therapy (HBO) for treating pneumocephalus, there is currently no literature on HBO efficacy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pneumocephalus typically implies a traumatic breach in the meningeal layer or an intracranial gas-producing infection. Unexplained pneumocephalus on a head computed tomography (CT) in an emergency setting often compels emergency physicians to undertake aggressive evaluation and consultation. In this paper, we report three cases of pneumocephalus that appear to result from retrograde injection of air through an intravenous (IV) catheter. We also performed a retrospective study to determine the incidence of presumed IV-induced pneumocephalus and etiologies of pneumocephalus in our emergency department (ED) population. The incidence of idiopathic and presumed IV-induced pneumocephalus was 0.034% among all head CTs ordered in the ED and 4.88% among cases of pneumocephalus seen in the ED. These cases are characterized clinically by the absence of signs and symptoms of pathologic pneumocephalus and radiographically by the distribution of air densities along the cranial venous system on head CTs. Idiopathic and presumed IV-induced pneumocephalus could be considered in the workup of ED patients with unexplained intracranial air on head CT if there are no findings of pathological causes for the pneumocephalus on history and physical examination and if the head CTs show a characteristic distribution of air limited to the cranial venous system. Knowledge of this clinical entity in the evaluation of ED patients with unexplained pneumocephalus can lead to more efficient emergency care and less patient anxiety.
    The western journal of emergency medicine 05/2010; 11(2):180-5.
Show more