Antonios Mammis1, Nitin Agarwal1, Jean Anderson Eloy1, James K Liu1. 1. Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States.
Abstract
BACKGROUND AND STUDY AIMS: Postoperative pneumocephalus is commonly observed after neurosurgical intracranial procedures and is usually of little consequence. Intraventricular tension pneumocephalus, however, is a rare complication and a neurosurgical emergency that requires immediate intervention. We describe the first case of intraventricular tension pneumocephalus that developed 1 week following an expanded endoscopic endonasal approach for resection of a suprasellar mass. PATIENT: A patient who underwent an endoscopic transplanum transtuberculum approach for resection of a suprasellar epidermoid tumor developed a sudden change in mental status, with imaging consistent with intraventricular tension pneumocephalus. Immediate endotracheal intubation and placement of an external ventricular drain prevented further deterioration. Endoscopic exploration of the skull base reconstruction revealed a one-way ball valve mechanism as the source of pneumocephalus. The skull base reconstruction was revised with autologous fascia lata and repositioning of the pedicled nasoseptal flap. CONCLUSION: Intraventricular tension pneumocephalus is a rare neurosurgical emergency that may develop after endoscopic skull base surgery. Initial management includes endotracheal intubation and placement of an external ventricular drain to decompress the ventricles. Endoscopic exploration and revision of the skull base repair is imperative to obliterate the ball-valve fistula to prevent further entrapment of air. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND AND STUDY AIMS: Postoperative pneumocephalus is commonly observed after neurosurgical intracranial procedures and is usually of little consequence. Intraventricular tension pneumocephalus, however, is a rare complication and a neurosurgical emergency that requires immediate intervention. We describe the first case of intraventricular tension pneumocephalus that developed 1 week following an expanded endoscopic endonasal approach for resection of a suprasellar mass. PATIENT: A patient who underwent an endoscopic transplanum transtuberculum approach for resection of a suprasellar epidermoid tumor developed a sudden change in mental status, with imaging consistent with intraventricular tension pneumocephalus. Immediate endotracheal intubation and placement of an external ventricular drain prevented further deterioration. Endoscopic exploration of the skull base reconstruction revealed a one-way ball valve mechanism as the source of pneumocephalus. The skull base reconstruction was revised with autologous fascia lata and repositioning of the pedicled nasoseptal flap. CONCLUSION:Intraventricular tension pneumocephalus is a rare neurosurgical emergency that may develop after endoscopic skull base surgery. Initial management includes endotracheal intubation and placement of an external ventricular drain to decompress the ventricles. Endoscopic exploration and revision of the skull base repair is imperative to obliterate the ball-valve fistula to prevent further entrapment of air. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Sean P Polster; Shirlene Obuobi; Victor J Del Brutto; Kenneth Avner; Aikaterini Markopoulou; Ricky H Wong Journal: Surg Neurol Int Date: 2018-09-21