Salih Hayder R, Jaafer Huda, Ismail Mustafa, Khallaf Ali Kareem, Mohammed Ali Jassim, Al-Mosawy Mohammad Sadeq M J, Naser Hawraa Sadiq, Maulood Ziyad Talal, Hafedh Anwar N, Hoz Samer S
Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.
Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq.
Surg Neurol Int. 2022 Dec 9;13:570. doi: 10.25259/SNI_948_2022. eCollection 2022.
Pneumocephalus (PNC) is a well-described consequence in postoperative settings and skull fractures that is usually self-limiting. It can get complicated into tension PNC on some rare occasions, leading to an intracranial mass effect. PNC was also reported after unintentional dural puncture throughout the epidural anesthesia process. However, tension PNC resulting from epidural anesthesia procedures is an extremely rare outcome that implies urgent intervention to relieve the tension within the brain. Here, we report a case of an extensive tension intraventricular PNC 2 days following an epidural anesthesia procedure for a femur fixation surgery.
A 23-year-old male presented to the emergency department with basal skull fractures and a femur fracture due to a motorcycle accident. His skull base fracture was managed conservatively then he underwent a femur fixation procedure under epidural anesthesia. Two days after, he developed a severe headache with a disturbed level of consciousness. Computed tomography of the brain revealed an extensive PNC that involved all the subarachnoid spaces down to the cervical region and compressing the cerebellum, which was not found in the initial imaging. The patient's status improved after the twist-drill burr-hole evacuation of air under the water seal.
Extensive tension PNC can occur after traumatic brain injury, especially after epidural anesthesia. Such cases should gain high focus because they may differ from simple PNC regarding diagnosis, treatment, and follow-up.
气颅是术后及颅骨骨折中一种常见的后果，通常具有自限性。在某些罕见情况下，它可能会发展为张力性气颅，导致颅内占位效应。硬膜外麻醉过程中意外硬膜穿刺后也有气颅的报道。然而，硬膜外麻醉操作导致的张力性气颅是一种极其罕见的结果，意味着需要紧急干预以缓解脑内张力。在此，我们报告一例在股骨固定手术硬膜外麻醉术后2天出现广泛的张力性脑室内气颅的病例。
一名23岁男性因摩托车事故导致颅底骨折和股骨骨折，被送往急诊科。其颅底骨折采用保守治疗，随后在硬膜外麻醉下行股骨固定手术。术后两天，他出现严重头痛，意识水平紊乱。脑部计算机断层扫描显示广泛的气颅，累及直至颈部区域的所有蛛网膜下腔，并压迫小脑，这在初始影像学检查中未发现。在水封下通过钻孔引流空气后，患者的状况有所改善。
广泛的张力性气颅可发生于创伤性脑损伤后，尤其是硬膜外麻醉后。此类病例应高度关注，因为它们在诊断、治疗和随访方面可能与单纯气颅不同。
