Toung T, Donham R T, Lehner A, Alano J, Campbell J
Neurosurgery. 1983 Feb;12(2):164-8. doi: 10.1227/00006123-198302000-00005.
Four cases of tension pneumocephalus after either posterior fossa craniotomy or translabyrinthine resection of acoustic neuroma with or without nitrous oxide anesthesia are described. Three of the operations were performed with the patient in the sitting position, and one was done with the patient in the lateral position. Of the three cases operated in the sitting position, no nitrous oxide was used at any time during anesthesia in one. Two patients failed to regain consciousness after the termination of anesthesia, and the other two developed the sudden onset of neurological symptoms 1 to 1.5 hours after the operation. In all cases computed tomography disclosed a large subdural collection of air. Re-exploration of the surgical wound or twist drill aspiration of the subdural air resulted in prompt recovery of neurological status in three patients, whereas the other patient's neurological status improved gradually without any specific treatment. The role played by nitrous oxide, the mechanisms by which air enters the intracranial space, the contributory factors, and the predisposing surgical conditions of tension pneumocephalus are reviewed and discussed. Dependent drainage of the cerebrospinal fluid, especially in a patient with coexisting hydrocephalus, seems to be the most important factor for the development of this complication.
本文描述了4例在后颅窝开颅手术或经迷路听神经瘤切除术（有无氧化亚氮麻醉）后发生张力性气颅的病例。其中3例手术患者为坐位，1例为侧卧位。在坐位进行手术的3例中，1例在麻醉期间任何时候均未使用氧化亚氮。2例患者在麻醉结束后未恢复意识，另外2例在术后1至1.5小时突然出现神经症状。所有病例的计算机断层扫描均显示硬膜下大量积气。对手术伤口进行再次探查或用钻颅法抽吸硬膜下气体后，3例患者的神经状态迅速恢复，而另1例患者的神经状态未经任何特殊治疗逐渐改善。本文对氧化亚氮所起的作用、空气进入颅内空间的机制、促成因素以及张力性气颅的易感手术条件进行了回顾和讨论。脑脊液的依赖引流，尤其是在并存脑积水的患者中，似乎是发生这种并发症的最重要因素。
