RESUMEN
OBJECTIVE: To describe a simple variation of burr hole craniostomy for the management of chronic subdural hematoma (CSDH) that uses a frontal drainage system to facilitate timely decompression in the event of tension pneumocephalus and spares the need for additional surgery. METHODS: We conducted a retrospective analysis of 20 patients with CSDH who underwent burr hole craniostomy and 20 patients who underwent the same procedure alongside the placement of a 5 Fr neonatal feeding tube as a backup drainage for the anterior craniostomy. Depending on the situation, the secondary drain stayed for a maximum of 72 hours to be opened and used in emergency settings for drainage, aspiration, or as a 1-way valve with a water seal. RESULTS: The outcomes of 20 patients who underwent this procedure and 20 controls are described. One patient from each group presented tension pneumocephalus. One was promptly resolved by opening the backup drain under a water seal to evacuate pneumocephalus and the other patient had to undergo a reopening of the craniostomy. CONCLUSIONS: The described variation of burr hole craniostomy represents a low-cost and easy-to-implement technique that can be used for emergency decompression of tension pneumocephalus. It also has the potential to reduce reoperation rates and CSDH recurrence. Prospective controlled research is needed to validate this approach further.
Asunto(s)
Drenaje , Hematoma Subdural Crónico , Neumocéfalo , Complicaciones Posoperatorias , Humanos , Hematoma Subdural Crónico/cirugía , Neumocéfalo/etiología , Neumocéfalo/cirugía , Neumocéfalo/diagnóstico por imagen , Drenaje/métodos , Masculino , Estudios Retrospectivos , Femenino , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Estudios de Cohortes , Craneotomía/métodos , Resultado del Tratamiento , Descompresión Quirúrgica/métodos , AdultoRESUMEN
INTRODUCTION: Pneumocephalus is a rare neuraxial blockade complication, which can be associated with severe neurologic changes. CLINICAL CASE: A 51-year-old patient was submitted to left total knee arthroplasty. Postoperatively, a pneumocephalus associated with decreased consciousness was diagnosed as a complication of the epidural analgesia. The treatment used was Hyperbaric Oxygen Therapy (HBOT) due to the severity of symptoms. Just after one session of HBOT, there was nearly full pneumocephalus resorption and significant clinical recovery. CONCLUSION: This case report enables anesthesiologists to recognize HBOT as a therapeutic option to be considered when treating severe cases of pneumocephalus.
Asunto(s)
Analgesia Epidural , Oxigenoterapia Hiperbárica , Neumocéfalo , Analgesia Epidural/efectos adversos , Humanos , Persona de Mediana Edad , Neumocéfalo/diagnóstico por imagen , Neumocéfalo/etiología , Neumocéfalo/terapiaRESUMEN
Tension pneumocephalus is an uncommon complication of neurosurgical procedures. We report a patient who presented with headache, vomiting, left hemiparesis and rhinorrhea 30 days after correction of a recurrent nasal cerebrospinal fluid fistula and shunt placement. A computed tomography scan revealed a massive collection of air with air-fluid level in the right sylvian fissure and midline shift. A right pterional craniotomy was performed and a small corticectomy resulted in evacuation of air from the sylvian fissure. A dural graft from the previous surgery was recognized to be acting as a ball-valve mechanism, trapping air from the nasal cavity. It was removed and the cranial defect was corrected with a split calvarial bone graft. Follow-up brain computed tomography revealed complete resolution of pneumocephalus. After surgery there was progressive improvement of neurological symptoms over 10 days, and the patient was asymptomatic after 1 month of follow-up.
Asunto(s)
Acueducto del Mesencéfalo/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/efectos adversos , Neumocéfalo/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/tendencias , Neumocéfalo/etiología , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Brain shift and pneumocephalus are major concerns regarding deep brain stimulation (DBS). OBJECTIVE: To report the extent of brain shift in deep structures and pneumocephalus in intraoperative magnetic resonance imaging (MRI). METHODS: Twenty patients underwent bilateral DBS implantation in an MRI suite. Volume of pneumocephalus, duration of procedure, and 6 anatomic landmarks (anterior commissure, posterior commissure, right fornix [RF], left fornix [LF], right putaminal point, and left putaminal point) were measured. RESULTS: Pneumocephalus varied from 0 to 32 mL (median = 0.6 mL). Duration of the procedure was on average 195.5 min (118-268 min) and was not correlated with the amount of pneumocephalus. There was a significant posterior displacement of the anterior commissure (mean = -1.1 mm, P < .001), RF (mean = -0.6 mm, P < .001), LF (mean = -0.7 mm, P < .001), right putaminal point (mean = -0.9 mm, P = .001), and left putaminal point (mean = -1.0 mm, P = .001), but not of the posterior commissure (mean = 0.0 mm, P = .85). Both RF (mean = -.7 mm, P < .001) and LF (mean = -0.5 mm, P < .001) were posteriorly displaced after a right-sided burr hole. There was a correlation between anatomic landmarks displacement and pneumocephalus after 2 burr holes (rho = 0.61, P = .007), but not after 1 burr hole (rho = 0.16, P = .60). CONCLUSION: Better understanding of how pneumocephalus displaces subcortical structures can significantly enhance our intraoperative decision making and overall targeting strategy.
Asunto(s)
Encéfalo/diagnóstico por imagen , Estimulación Encefálica Profunda/efectos adversos , Monitorización Neurofisiológica Intraoperatoria/métodos , Imagen por Resonancia Magnética/métodos , Neumocéfalo/etiología , Puntos Anatómicos de Referencia , Estimulación Encefálica Profunda/instrumentación , Estimulación Encefálica Profunda/métodos , Humanos , Neumocéfalo/diagnóstico por imagen , Trepanación/efectos adversosRESUMEN
Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain andmultiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment.
Asunto(s)
Humanos , Masculino , Adulto , Neumocéfalo/etiología , Traumatismos Craneocerebrales/complicaciones , Neumocéfalo/cirugía , Neumocéfalo/diagnóstico , Tomografía Computarizada por Rayos X , Derivación Ventriculoperitoneal , Pérdida de Líquido Cefalorraquídeo/cirugía , Pérdida de Líquido Cefalorraquídeo/etiologíaRESUMEN
Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography. In this paper, we report a case of a 12-year-old male patient who had suffered a TBI and presented with several pneumocephali, one of them in the retroclival region, causing a mass effect and then compression of the sixth cranial nerve which is the most susceptible to these injuries. We discuss these traumatic posterior fossa lesions, with an emphasis on retroclival pneumocephalus, not yet described in the literature in association with bilateral abducens palsy. In addition, we discuss associated lesions and the trauma mechanism.
Asunto(s)
Enfermedades del Nervio Abducens/complicaciones , Enfermedades del Nervio Abducens/diagnóstico , Neumocéfalo/complicaciones , Neumocéfalo/diagnóstico , Neumocéfalo/etiología , Enfermedades del Nervio Abducens/cirugía , Niño , Humanos , Masculino , Neumocéfalo/cirugíaAsunto(s)
Rinorrea de Líquido Cefalorraquídeo/etiología , Neumocéfalo/etiología , Sinusitis/complicaciones , Adulto , Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Enfermedad Crónica , Femenino , Humanos , Neumocéfalo/diagnóstico por imagen , Radiografía , Sinusitis/diagnóstico por imagenAsunto(s)
Humanos , Femenino , Adulto , Neumocéfalo/etiología , Sinusitis/complicaciones , Rinorrea de Líquido Cefalorraquídeo/etiología , Neumocéfalo/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Radiografía , Rinorrea de Líquido Cefalorraquídeo/diagnóstico por imagen , Enfermedad CrónicaRESUMEN
Pneumoventricle is a common postoperative event following posterior fossa approach, or any transventricular approach, with a benign evolution, rarely life-threatning. However, spontaneous pneumoventricle is a rare condition, almost always secondary to cerebrospinal fluid (CSF) leakage, with possible worse evolution. We describe a 57-year-old woman, previously healthy, submitted 7 months ago to a bariatric surgery, losing 110 pounds (50 Kg) since that, who developed 1 month ago headache, hemiparesis and incontinence, secondary to a spontaneous pneumoventricle. (au)
O pneumoventrículo é um evento comum no pós-operatório de cirurgias de fossa posterior, ou acessos transventriculares, com uma evolução benigna, raramente letal. Já o pneumoventrículo espontâneo é uma condição rara, quase sempre associado com fístula liquórica, com possível pior prognóstico. Neste trabalho descrevemos uma mulher de 57 anos, previamente hígida, submetida há 7 meses a uma cirurgia bariátrica, perdendo 50 Kg desde então, que há 1 mês apresentou cefaléia, hemiparesia e incontinência vesical, secundárias a um pneumoventrículo espontâneo.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Cirugía Bariátrica/efectos adversos , Neumocéfalo/cirugía , Neumocéfalo/etiología , Cefalea , Meningocele , Neumocéfalo/diagnóstico , Paresia , Incontinencia UrinariaAsunto(s)
Quistes Aracnoideos/cirugía , Tronco Encefálico , Quistes del Sistema Nervioso Central/cirugía , Traumatismos Cerrados de la Cabeza/diagnóstico , Quistes Aracnoideos/diagnóstico , Tronco Encefálico/patología , Quistes del Sistema Nervioso Central/diagnóstico , Niño , Epilepsia Tónico-Clónica/etiología , Exotropía/etiología , Femenino , Estudios de Seguimiento , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Hallazgos Incidentales , Imagen por Resonancia Magnética , Examen Neurológico , Atrofia Óptica/etiología , Neumocéfalo/etiología , Complicaciones Posoperatorias/etiología , Convulsiones Febriles/etiología , Tomografía Computarizada por Rayos X , Derivación VentriculoperitonealRESUMEN
Justificativa e Objetivos: O bloqueio peridural constitui técnica utilizada para alívio da dor durante o trabalho de parto. Apesar das vantagens, näo é isenta de complicaçöes, como, por exemplo, o pneumoencéfalo iatrogênico, diagnosticado após bloqueio peridural, com punçäo acidental de duramáter. Relato de caso: Paciente de 16 anos, estado físico ASA I, sem antecedentes anestésicos, submetida a bloqueio peridural contínuo para analgesia de parto. Após várias tentativas de punçöes no espaço L3-L4, ocorreu punçäo acidental de duramáter. Optou-se por nova punçäo em L3-L4, e após identificaçäo do espaço peridural empregando-se a técnica da perda da resistência com ar, injetou-se o anestésico local e fentanil, seguido de passagem do cateter. Após 20 minutos da instalaçäo do bloqueio, ocorreu sofrimento fetal, com indicaçäo de cesariana, sendo administrada dose complementar de anestésico local pelo cateter. A paciente permaneceu hemodinamicamente estável e consciente durante a cirurgia, com lenta recuperaçäo do bloqueio motor (14 h). No pós-operatório, apresentou dois episódios de crise convulsiva, com intervalo de 12 horas entre eles, que reverteram espontaneamente. A avaliaçäo neurológica era normal e a tomografia computadorizada revelou imagem com densidade de ar compatível com pneumoencéfalo. A paciente teve alta três dias após, sem seqüelas. Conclusöes: O caso confirma a possibilidade de se causar pneumoencéfalo iatrogênico durante a realizaçäo de bloqueio peridural, empregando-se a técnica da perda de resistência ao ar para a identificaçäo do espaço peridural. Na presença de sinais e sintomas de irritaçäo meníngea, a tomografia computaforizada é o meio diagnóstico recomendado para o diagóstico diferencial entre pneumoencéfalo e as demais causas
Asunto(s)
Humanos , Adolescente , Femenino , Embarazo , Analgesia Epidural/efectos adversos , Duramadre/lesiones , Trabajo de Parto , Neumocéfalo/etiología , Analgesia Obstétrica/efectos adversos , Tomografía Computarizada por Rayos XRESUMEN
Se presentan 4 pacientes con neumoencéfalos atendidos en el Hospital General Docente "Agostinho Neto" de Guantánamo a lo largo de 6 años. Todos eran varones con una edad media de 38,2 años. La causa más frecuente fue de origen traumático, presente en 3 pacientes para el 75 porciento. La disminución progresiva del nivel de conciencia y la agitación psicomotriz presentes en el 75 porciento de los enfermos fueron las manifestaciones clínicas más usuales en el período inicial, mientras que en el período de estado predominó el coma profundo (escala de Glasgow menor o igual a 8 puntos) en el 50 porciento de los pacientes. La localización más frecuente del aire se describió en el espacio subdural en el 50 porciento de los enfermos. En un solo paciente se presentó el neumoencéfalo a tensión. El neumoencéfalo se asoció con una alta mortalidad y en nuestro reporte el 50 porciento de los pacientes fallecieron (AU)