Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus
ABSTRACT 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.
Article: Commentary.01/2014; 5(1):70-1.
The Journal of Clinical Endocrinology and Metabolism 04/2014; 99(7):jc20133865. DOI:10.1210/jc.2013-3865 · 6.31 Impact Factor
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ABSTRACT: E pidural steroid injections are a mainstay in the treat-ment of radicular pain. These procedures have a low incidence of adverse events and may provide symp-tomatic pain relief for patients with extremity pain due to a herniated disk, chemical irritation of a nerve root, foraminal stenosis, and central canal stenosis. 1 Pneumocephalus is an uncommon complication that can occur after dural punc-ture. 2 Prompt recognition, treatment, and patient reassur-ance are essential components of successful management. We report a case of pneumocephalus occurring after an inadvertent dural puncture during an interlaminar lum-bar epidural steroid injection for bilateral lower extremity pain related to spinal pathology. Patient consent was not obtained; however, consent to publish the patient informa-tion was obtained from the University of Florida IRB after review of the manuscript. CASE DESCRIPTION A male patient in his late 70s presented with complaints of bilateral lower extremity pain. His symptoms were consistent with the findings on magnetic resonance imag-ing including central spinal stenosis from the ligamentum flavum hypertrophy of T11 through S1 and radiculopathy from a herniated nucleus pulposus at L4-L5 contacting the descending L5 and S1 nerve roots. His body mass index was within the normal range. He was referred to the pain clinic for conservative management, including lumbar epidural steroid injections. The patient had previously received 2 interlaminar epidural injections separated by 3 months with good relief of his symptoms.Anesthesia and analgesia 01/2014; DOI:10.1213/XAA.0000000000000055 · 3.42 Impact Factor