Article

Diffuse Pneumocephalus : A Rare Complication of Spinal Surgery

Department of Neurosurgery, Dankook University Medical College, Cheonan, Korea.
Journal of Korean Neurosurgical Society (Impact Factor: 0.64). 09/2010; 48(3):288-90. DOI: 10.3340/jkns.2010.48.3.288
Source: PubMed
ABSTRACT
The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2 weeks with conservative management.

Full-text preview

Available from: ncbi.nlm.nih.gov
288
www.jkns.or.kr
Diffuse Pneumocephalus :
A Rare Complication of Spinal Surgery
Jung Ho Yun, M.D.,
1
Young Jin Kim, M.D., Ph.D.,
1
Dong Soo Yoo, M.D., Ph.D.,
2
Jung Ho Ko, M.D.
3
Departments of Neurosurgery,
1
Radiology,
2
Dankook University Medical College, Cheonan, Korea
Department of Neurosurgery,
3
Konyang University Hospital, Daejeon, Korea
J Korean Neurosurg Soc 48
:
288-290, 2010
The common etiologies of pneumocephalus, presence of air in the intracranial cavity, are trauma and cranial surgery. Pneumocephalus after
spinal surgery is an unusual postoperative complication. We report the case of a male 59-year-old man who developed a pneumacephalus after
posterior lumbar surgery for spinal stenosis. Intraoperatively, a cerebrospinal fluid leak following a dural tear was noted and immediately
repaired. The next day, the patient complained of headache and dizziness. Head and lumbar computed tomography scans revealed significant air
in the frontal region, several cisterns, intraventricle, and extra-dural area in the spine canal. Symptoms were spontaneously resolved within 2
weeks with conservative management.
KEY WORDS : Pneumocephalus
˙
Spinal surgery
˙
Dura tearing
10.3340/
jkns
.2010.48.3.288
Case Report
Copyright
©
2010 The Korean Neurosurgical Society
Print ISSN 2005-3711 On-line ISSN 1598-7876
INTRODUCTION
Pneumocephalus is defined as the presence of intracranial
gas
1)
. It usually occurs when fractures of temporal bone air
cells or paranasal sinuses tear the adjacent dura
6,8)
. Other rare
causes of pneumocephalus include traumatic or iatrogenic
spinal dura tear
11,13,16,17)
. Due to recent advances in instru-
mentation of spinal surgery, dural tears are inevitable and
surgeons are faced with increasing numbers of cerebrospinal
fluid (CSF) leaks. Tears in the dural sac and CSF leakage
during post spinal surgery may lead to post-operative com-
plications, such as meningitis, arachnoiditis, epidural abscess,
delay of wound healing, dural-cutaneous fistula, and pneu-
mocephalus
4)
. We report a case of symptomatic pneumoce-
phalus after lumbar spinal surgery. With this case report and
brief literature review, we hope to make spinal surgeons more
aware of pneumocephalus as a potential cause of headache
and dizziness following spinal operation.
CASE REPORT
History and Examination
A 59-year-old man presented with a tingling sensation and
pain in both lower extremities of 6-months’ duration. At
admission, he complained of slight motor weakness of right
foot. There was no significant medical history of or any
recent history of trauma. Neurological examination revealed
decreased motor strength in ankle dorsiflexion (4/5) on the
right. Paresthesia and hypesthesia were present in both the L5
and S1 dermatomes. Both ankle reflexes were diminished
and gait was unsteady due to pain and weakness in the leg.
Neurologic claudication was precipitated by walking about
50 meters and relieved by a change in posture to squatting or
to sitting. The patient denied any bowel or bladder dysfunc-
tion. Magnetic resonance (MR) imaging demonstrated se-
vere spinal canal narrowing caused by hypertrophy of the
facets and the ligament flavum with central protrusion of the
disc at the L4-5 and L5-S1 levels. Unsuccessful nonoperative
treatments at a regional hospital for 2-months led him to the
decision to undergo surgery.
Operations
The dissection and retraction of paraspinal muscles were
completed by a posterior midline approach. The following
Received : October 25, 2009
Revised : June 16, 2010
Accepted : August 3, 2010
Address for reprints : Young Jin Kim, M.D., Ph.D.
Department of Neurosurgery, Dankook University Medical College,
San 29 Anseo-dong, Cheonan 330-714, Korea
Tel : +82-41-550-3979, Fax : +82-41-552-6870
E-mail : spine1225@yahoo.co.kr
Page 1

You are reading a preview. Would you like to access the full-text?

  • Source
    • "X-ray graphy, cranial CT and MRI may be used as diagnostic tools. The capability of detecting 0.5 cc of air enables the use of CT as a highly specific and sensitive diagnostic tool [1, 2, 6]. We used CT to make a diagnosis of pneumocephalus and detected pneumocephalus mainly in the frontal region. "
    [Show abstract] [Hide abstract] ABSTRACT: Symptomatic pneumocephalus is frequently seen after traumatic fracture of the skull base bone. However, it has rarely been reported after spinal surgery and its mechanism has not been fully explained. In this paper, we present a 30 year old male patient who had lumbar discectomy due to a symptomatic midline lumbar disc herniation. He had developed symptomatic pneumocephalus after the lumbar disc surgery associated with application of a vacuum suction device. We present and discuss our patient in the light of the literatures.
    Full-text · Article · Feb 2015 · Macedonian Journal of Medical Sciences
  • Source
    • "Spinal cerrahi esnasında istem-dışı durotomi meydana gelmesi ve beyin omurilik sıvısı (BOS) kaçağı olması iyi bilinen, sıkça karşılaşılabilen komplikasyondur (3). Bu yazıda rekküren disk herniasyonu nedeniyle opere edilen, cerrahi esnasında meydana gelen istem-dışı durotomiyi takiben ortaya çıkan semptomatik bir pnömosefali olgusu sunulmaktadır.2, 7, 12, 14, 18, 20, 24). Pnömosefali, intrakraniyal kavitede, epidural, subdural, subaraknoid, intraventriküler ya da intraparankimal olarak görülebilir (24). "
    [Show abstract] [Hide abstract] ABSTRACT: Kraniyal boşluklarda hava bulunması olarak tanımlanan pnömosefali, nöroşirürjiyenler tarafından çok iyi bilinen bir durumdur. Pnömosefalinin spinal nedenleri arasında; spinal travmalar, penetran yaralanmalar, tümörler, enfeksiyonlar ile lomber ponksiyon ve laparoskobik biyopsi gibi iyatrojenik sebepler yer almaktadır. Spinal cerrahi esnasında istem-dışı durotomi meydana gelmesi ve beyin omurilik sıvısı kaçağı olması iyi bilinen ve sıkça karşılaşılabilen bir komplikasyondur. Lomber disk cerrahisinin bir komplikasyonu olarak pnömosefali ortaya çıkması çok nadir bir durumdur. Bu yazıda, rekküren disk herniasyonu nedeniyle opere edilen ve operasyon esnasında istem-dışı durotomi meydana gelmesini takiben semptomatik pnömosefali gelişen 54 yaşında bir kadın olgu sunulmaktadır. Postoperatif 1. günde şiddetli baş ağrısı, dengesizlik ve kusma yakınmaları başlaması üzerine çekilen bilgisayarlı beyin tomografisinde pnömosefali tespit edildi. Konservatif tedavi ile şikayetleri düzelen hasta bir hafta sonra nörolojik defisiti ve ağrısı olmadan taburcu edildi. ABSTRACT Pneumocephalus, the presence of air in the cerebral cavity, is a well known entity for neurosurgeons. A spinal origin of pneumocephalus may be associated with spinal trauma, penetrating injury, tumors, infections, and iatrogenic causes such as lumbar puncture and laparoscopic biopsy. Involuntary durotomy and cerebrospinal fluid leakage during spinal surgery are well known complications. Lumbar disc surgery is rarely complicated with pneumocephalus. Here we present a case of a 54-year-old woman who underwent lumbar disc surgery for recurrent herniation in whom pneumocephalus occurred after intraoperative involuntary durotomy. The patient began to complain of headache and dizziness, and began vomiting on the first postoperative day. Head computed tomography scan revealed diffuse pneumocephalus. Her symptoms gradually improved and she was discharged free of pain with no neurological deficit after a week.
    Full-text · Article · Jan 2011
  • Source
    [Show abstract] [Hide abstract] ABSTRACT: We present a case report of a 45-year-old woman with spontaneous pneumocephalus accompanied by pneumorrhachis of the thoracic spine, which is a very rare condition generally associated with trauma and thoracic or spinal surgery. The patient had undergone an operation about 10 years earlier to treat a giant cell tumor of the thoracic spine. During the operation, a metallic device was installed, which destroyed the bronchus and caused the formation of a broncho-paraspinal fistula. This is the suspected cause of her pneumocephalus and pneumorrhachis. To our knowledge, this is a very rare case of pneumocephalus accompanied by pneumorrhachis induced by metallic device, and when considering the length of time after surgery these complications presented are also exceptional.
    Full-text · Article · Jul 2011 · Journal of Korean Neurosurgical Society
Show more