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01-03-2018 | Original Article - Neurosurgical Techniques

Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

Authors: Alexandra Sachkova, Timm Schemmerling, Maria Goldberg, Volodymyr Solomiichuk, Veit Rohde, Kajetan L. von Eckardstein, Bawarjan Schatlo

Published in: Acta Neurochirurgica | Issue 3/2018

Abstract

Background

Ventricular pneumocephalus is a rare but potentially life-threatening complication of cranial surgery in the sitting position.

Objective

The objective of the study is to assess the incidence and risk factors of postoperative ventricular pneumocephalus.

Methods

We performed a retrospective chart review of 307 consecutive patients (147 men, 160 women) treated at our institution by intracranial surgery in the sitting position from January 2010 to October 2014. Ventricular air entrapment with lack of arousal or neurologic deterioration requiring external ventriculostomy (EVD) was defined as ventricular tension pneumocephalus (VTP). Demographic variables were recorded along with radiological and clinical data. The occurrence of pneumocephalus was correlated with patient-related and surgical variables.

Results

VTP was observed in 12 cases (3.9%). These patients had higher intraventricular air volumes (48.5 cm³ (CI 95% [29.06–67.86])) compared to asymptomatic patients (7.4 cm³ (CI 95% [5.43–9.48])). Opening of the fourth ventricle was the most potent predictor of VTP (OR = 34.7, CI 95% [4.4–273.5], p = 0.001). In patients undergoing no additional treatment for pneumocephalus, ventricular air volume declined to an average of 41.7% of the initial postoperative volume on postoperative day 3.

Conclusions

Entrapment of intracranial and particularly ventricular air requiring emergent EVD occurred in 3.9% cases of intracranial surgery in the sitting position. Especially the opening of the fourth ventricle was associated with the development of VTP, which should warrant particularly diligent postoperative observation of these patients. In cases without neurological symptoms, the rate of spontaneous air resorption is sufficiently high to warrant expectant management.

Aydoseli A, Akcakaya MO, Aras Y, Boyali O, Unal OF (2013) Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus. Turk Neurosurg 23(4):564–567PubMed

Banu MA, Szentirmai O, Mascarenhas L, Salek AA, Anand VK, Schwartz TH (2014) Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks. J Neurosurg 121(4):961–975CrossRefPubMed

Beseoglu K, Lodes S, Stummer W, Steiger HJ, Hänggi D (2011) The transorbital keyhole approach: early and long-term outcome analysis of approach-related morbidity and cosmetic results. Technical note. J Neurosurg 114(3):852–856. https://doi.org/10.3171/2010.9.JNS1095 CrossRefPubMed

Blount A, Riley K, Cure J, Woodworth BA (2012) Cerebrospinal fluid volume replacement following large endoscopic anterior cranial base resection. Int Forum Allergy Rhinol 2(3):217–221CrossRefPubMed

Chandler JP, Pelzer HJ, Bendok BB, Hunt Batjer H, Salehi SA (2005) Advances in surgical management of malignancies of the cranial base: the extended transbasal approach. J Neuro-Oncol 73(2):145–152CrossRef

Coffey CE, Lucke JF, Saxton JA, Ratcliff G, Unitas LJ, Billig B, Bryan RN (1998) Sex differences in brain aging: a quantitative magnetic resonance imaging study. Arch Neurol 55(2):169–179CrossRefPubMed

Daszkiewicz P, Dziedzic D (2017) Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population. Neurol Neurochir Pol 51(4):286–289PubMed

Dexter F, Reasoner DK (1996) Theoretical assessment of normobaric oxygen therapy to treat pneumocephalus. Anesthesiology 84(2):442–447CrossRefPubMed

Di Lorenzo N, Caruso R, Floris R, Guerrisi V, Bozzao L, Fortuna A (1986) Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study. Acta Neurochir 83(3–4):112–115CrossRefPubMed

10.

Domaingue CM (2005) Anaesthesia for neurosurgery in the sitting position: a practical approach. Anaesth Intensive Care 33(3):323–331PubMed

11.

Dudoit T, Labeyrie PE, Deryckere S, Emery E, Gaberel T (2016) Is systematic post-operative CT scan indicated after chronic subdural hematoma surgery? A case-control study. Acta Neurochir 158(7):1241–1246. https://doi.org/10.1007/s00701-016-2820-6 CrossRefPubMed

12.

Fathi A-R, Eshtehardi P, Meier B (2009) Patent foramen ovale and neurosurgery in sitting position: a systematic review. Br J Anaesth 102(5):588–596CrossRefPubMed

13.

Gore PA, Maan H, Chang S, Pitt AM, Spetzler RF, Nakaji P (2008) Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus. J Neurosurg 108(5):926–929CrossRefPubMed

14.

Greenberg MS (2016) Handbook of Neurosurgery. Thieme

15.

Gur RC, Mozley PD, Resnick SM, Gottlieb GL, Kohn M, Zimmerman R, Herman G, Atlas S, Grossman R, Berretta D (1991) Gender differences in age effect on brain atrophy measured by magnetic resonance imaging. Proc Natl Acad Sci U S A 88(7):2845–2849CrossRefPubMedPubMedCentral

16.

Haran RP, Chandy MJ (1997) Symptomatic pneumocephalus after transsphenoidal surgery. Surg Neurol 48(6):575–578CrossRefPubMed

17.

Harris AE, Hadjipanayis CG, Lunsford LD, Lunsford AK, Kassam AB (2008) Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance. Neurosurgery 62(Suppl 2):622–629PubMed

18.

Hernández-Palazón J, Martínez-Lage JF, de la Rosa-Carrillo VN, Tortosa JA, López F, Poza M (2003) Anesthetic technique and development of pneumocephalus after posterior fossa surgery in the sitting position. Neurocir Astur Spain 14(3):216–221CrossRef

19.

Himes BT, Mallory GW, Abcejo AS et al (2017) Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg 127(1):182–188CrossRefPubMed

20.

Hong B, Biertz F, Raab P et al (2015) Normobaric hyperoxia for treatment of pneumocephalus after posterior fossa surgery in the semisitting position: a prospective randomized controlled trial. PLoS One 10(5):e0125710CrossRefPubMedPubMedCentral

21.

Ihab Z (2012) Pneumocephalus after surgical evacuation of chronic subdural hematoma: is it a serious complication? Asian J Neurosurg 7(2):66–74. https://doi.org/10.4103/1793-5482.98647 CrossRefPubMedPubMedCentral

22.

Kryzanski JT et al (2008) Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull Base

23.

Kuba H, Matsukado K, Inamura T, Morioka T, Sasaki M, Fukui M (2000) Pneumocephalus associated with aqueductal stenosis: three-dimensional computed tomographic demonstration of skull-base defects. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 16(1):1–3CrossRef

24.

Kumar R, Singh S (2005) Childhood choroid plexus papillomas: operative complications. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 21(2):138–143CrossRef

25.

Leslie K, Hui R, Kaye AH (2006) Venous air embolism and the sitting position: a case series. J Clin Neurosci Off J Neurosurg Soc Australas 13(4):419–422

26.

Lunsford LD, Maroon JC, Sheptak PE, Albin MS (1979) Subdural tension pneumocephalus. Report of two cases. J Neurosurg 50(4):525–527CrossRefPubMed

27.

Maduri R, Daniel R-T, Diezi M, Cotting J, Messerer M (2016) Paraplegia after posterior fossa surgery in prone position: can we prevent it? Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg. https://doi.org/10.1007/s00381-016-3314-9

28.

Menon G, Nair SN, Baldawa SS, Rao RB, Krishnakumar KP, Gopalakrishnan CV (2010) Choroid plexus tumors: an institutional series of 25 patients. Neurol India 58(3):429–435. https://doi.org/10.4103/0028-3886.66455 CrossRefPubMed

29.

Nazzaro JM, Lyons KE, Honea RA, Mayo MS, Cook-Wiens G, Harsha A et al (2010) Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery. Acta Neurochir 152:2047–2052CrossRefPubMed

30.

Paiva WS, de Andrade AF, Figueiredo EG, Amorim RL, Prudente M, Teixeira MJ (2014) Effects of hyperbaric oxygenation therapy on symptomatic pneumocephalus. Ther Clin Risk Manag 10:769–773CrossRefPubMedPubMedCentral

31.

Porter JM, Pidgeon C, Cunningham AJ (1999) The sitting position in neurosurgery: a critical appraisal. Br J Anaesth 82(1):117–128CrossRefPubMed

32.

Reasoner DK, Todd MM, Scamman FL, Warner DS (1994) The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology 80(5):1008–1012CrossRefPubMed

33.

Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40(1):11–21 discussion 21-23 PubMed

34.

Senior BA, Ebert CS, Bednarski KK, Bassim MK, Younes M, Sigounas D, Ewend MG (2008) Minimally invasive pituitary surgery. Laryngoscope 118(10):1842–1855. https://doi.org/10.1097/MLG.0b013e31817e2c43 CrossRefPubMed

35.

Sharim J, Pezeshkian P, DeSalles A, Pouratian N (2015) Effect of cranial window diameter during deep brain stimulation surgery on volume of Pneumocephalus. Neuromodulation 18(7):574–578. https://doi.org/10.1111/ner.12328 discussion 578-9 CrossRefPubMedPubMedCentral

36.

Sloan T (2010) The incidence, volume, absorption, and timing of supratentorial pneumocephalus during posterior fossa neurosurgery conducted in the sitting position. J Neurosurg Anesthesiol 22(1):59–66CrossRefPubMed

37.

Solomiichuk VO, Lebed VO, Drizhdov KI (2013) Posttraumatic delayed subdural tension pneumocephalus. Surg Neurol Int 4:37CrossRefPubMedPubMedCentral

38.

Suri A, Mahapatra AK, Singh VP (2000) Posterior fossa tension pneumocephalus. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 16(4):196–199CrossRef

39.

Toung T, Donham RT, Lehner A, Alano J, Campbell J (1983) Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus. Neurosurgery 12(2):164–168CrossRefPubMed

40.

Toung TJ, McPherson RW, Ahn H, Donham RT, Alano J, Long D (1986) Pneumocephalus: effects of patient position on the incidence and location of aerocele after posterior fossa and upper cervical cord surgery. Anesth Analg 65(1):65–70CrossRefPubMed

41.

Xu F, Tang Z, Luo X, Kang H, Zhu W, Wang G, Xu K, Lian L, Zhu S (2014) Pneumocephalus following the minimally invasive hematoma aspiration and thrombolysis for ICH. Br J Neurosurg 28(6):776–781. https://doi.org/10.3109/02688697.2014.920486 CrossRefPubMed

42.

Yates H, Hamill M, Borel CO, Toung TJ (1994) Incidence and perioperative management of tension pneumocephalus following craniofacial resection. J Neurosurg Anesthesiol 6(1):15–20CrossRefPubMed

43.

(1999) Literature review. J Clin Neurosci Off J Neurosurg Soc Australas 6(5):420–424

Title: Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position
Authors: Alexandra Sachkova
Timm Schemmerling
Maria Goldberg
Volodymyr Solomiichuk
Veit Rohde
Kajetan L. von Eckardstein
Bawarjan Schatlo
Publication date: 01-03-2018
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 3/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-017-3444-1

ACC 2024 Congress

Springer Medicine

Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

Abstract

Background

Objective

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusions

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