Hospital Universitário Walter Cantídio/Universidade Federal do Ceará, Fortaleza, Brazil.
Hospital Universitário Walter Cantídio/Universidade Federal do Ceará, Fortaleza, Brazil.
World Neurosurg. 2021 Jul;151:87-88. doi: 10.1016/j.wneu.2021.04.102. Epub 2021 Apr 30.
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.
张力性气颅是神经外科手术的一种罕见并发症。我们报告了 1 例患者，该患者在复发的鼻脑脊液漏修补和分流术后 30 天出现头痛、呕吐、左侧偏瘫和鼻漏。计算机断层扫描显示右大脑外侧裂有大量气腔，伴有气液平面和中线移位。行右翼点开颅术，小骨窗切开术导致气从大脑外侧裂排出。发现先前手术中的硬脑膜移植物充当活瓣机制，将鼻腔中的空气困在其中。将其切除，并用颅骨骨瓣劈开修补颅骨缺损。随访脑计算机断层扫描显示气颅完全消退。术后 10 天内神经症状逐渐改善，随访 1 个月后患者无症状。
