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Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: A prospective study

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Summary

Thirty patients subjected to posterior fossa surgery in the sitting position were evaluated postoperatively by CT scans in order to assess the true incidence of pneumocephalus and subsequent development, if any, of tension pneumocephalus. This prospective survey shows that the postoperative incidence of intracranial air was 100%, while no progression towards tension pneumocephalus producing severe neurological deterioration was observed. It can thus be claimed that, although the sitting position may favour the development of tension pneumocephalus also other factors contribute to its pathogenesis. Finally, neither nitrous oxide nor temperature play any significant role in the development of this complication.

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References

  1. Black PMcL, Davis JM, Kjellberg RN, Davis KR (1979) Tension pneumocephalus of the cranial subdural space: a case report. Neurosurgery 5: 368–370

    PubMed  Google Scholar 

  2. Bremer AM, Nguyen TQ (1982) Tension pneumocephalus after surgical treatment of chronic subdural hematoma: report of three cases. Neurosurgery 11: 284–287

    PubMed  Google Scholar 

  3. Friedman GA, Norfleet EA, Bedford RF (1981) Discontinuance of nitrous oxide does not prevent tension pneumocephalus. Anesth Analg (Paris) 60: 57–58

    Google Scholar 

  4. Grundy BL, Spetzler RF (1980) Subdural pneumocephalus resulting from drainage of cerebrospinal fluid during craniotomy. Anesthesiology 52: 269–271

    PubMed  Google Scholar 

  5. Haines SJ, Maroon JC, Jannetta PJ (1978) Supratentorial intracranial haemorrhage following posterior fossa surgery. J Neurosurg 49: 881–886

    PubMed  Google Scholar 

  6. Harders A, Gilsbach J, Weigel K (1985) Supratentorial space-occupying lesions following intratentorial surgery. Early diagnosis and treatment. Acta Neurochir (Wien) 74: 57–60

    Google Scholar 

  7. Hulett WB, Laing JW (1976) Tension pneumocephalus and the sitting position. Anesthesiology 45: 578 (letter)

    Google Scholar 

  8. Ikeda K, Nakane M, Tani E (1978) Tension pneumocephalus complicating ventriculoperitoneal shunt for cerebrospinal fluid rhinorrhea: case report. J Neurol Neurosurg Psychiatr 41: 319–322

    PubMed  Google Scholar 

  9. Kitahata LM, Katz JD (1976) Tension pneumocephalus after posterior fossa craniotomy, a complication of the sitting position. Anaesthesiology 44: 448–450

    Google Scholar 

  10. Leunda G, Cabezudo JM, Areitio E, Vaquero J, Gilsanz F (1981) Subdural tension pneumocephalus after posterior fossa operation: is the inverted bottle phenomenon the only causative factor? Surg Neurol 15: 303–305

    PubMed  Google Scholar 

  11. Little JR, MacCarty CS (1976) Tension pneumocephalus after insertion of ventriculoperitoneal shunt for aqueductal stenosis: case report. J Neurosurg 44: 383–385

    PubMed  Google Scholar 

  12. Lunsford LD, Maroon JD, Sheptak PE, Albins MS (1979) Subdural tension pneumocephalus: report of two cases. J Neurosurg 50: 525–527

    PubMed  Google Scholar 

  13. MacGilliverg RG (1982) Pneumocephalus as a complication of posterior fossa surgery in the sitting position. Anesthesia 37: 722–725

    Google Scholar 

  14. Mallamo JT, Hubbard RB, Boone SC, Reisner LS, Pister JD (1979) Expansion of air-filled subdural space during nitrous oxide anesthesia. Radiology 115: 369–372

    Google Scholar 

  15. Muizelaar JP, Walder HAD (1967) Tension pneumocephalus following insertion of ventriculoatrial shunt after severe head trauma: case report. Clin Neurol Neurosurg 80: 57–61

    Google Scholar 

  16. Pitts LH, Wilson CB, Dedo HH, Weyand R (1975) Pneumocephalus following ventriculoperitoneal shunt: case report. J Neurosurg 43: 631–633

    PubMed  Google Scholar 

  17. Raggio JF, Fleischer AS, Sung YF, Hoffman JC (1979) Expanding pneumocephalus due to nitrous oxide anesthesia: case report. Neurosurgery 4: 261–263

    PubMed  Google Scholar 

  18. Saidman LJ, Eger EI II (1965) Change in cerebrospinal pressure during pneumocephalography under nitrous oxide anesthesia. Anesthesiology 26: 67–72

    PubMed  Google Scholar 

  19. Standefer M, Bay JW, Trusso R (1984) The sitting position in neurosurgery: a retrospective analysis of 488 cases. Neurosurgery 14: 649–658

    PubMed  Google Scholar 

  20. Steinberg A, Antunes JL, Michelsen WJ (1979) Pneumocephalus after ventriculoatrial shunt. Neurosurgery 5: 708–710

    PubMed  Google Scholar 

  21. Toung T, Donham RT, Lehener A, Alano J, Campbell J (1983) Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus. Neurosurgery 12: 164–168

    PubMed  Google Scholar 

  22. Witcombe JB, Torrens MJ, Gye RS (1976) Intracerebral pneumatocele: an unusual complication following intraventricular drainage in a case of benign intracranial hypertension. Neuroradiology 12: 161–163

    PubMed  Google Scholar 

  23. Wolf S, Albin MS (1980) Anesthetic management of pneumocephalus. Anesthesiology 5: 521

    Google Scholar 

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Di Lorenzo, N., Caruso, R., Floris, R. et al. Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: A prospective study. Acta neurochir 83, 112–115 (1986). https://doi.org/10.1007/BF01402388

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  • DOI: https://doi.org/10.1007/BF01402388

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