Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis

Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.

Tension pneumocephalus following endoscopic resection of a mediastinal thoracic spinal tumor:A case report

BACKGROUND Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation.We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management.CASE SUMMARY A 66-year-old man who received thoracoscopic resection to remove an intrathoracic,posterior mediastinal,dumbbell-shaped,pathology-proven neurogenic tumor.The patient then reported experiencing progressively severe headaches,especially when in an upright position.A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus.Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient.During the operation,we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level.After that,we wrapped and sealed all the possible origins of the leakage with autologous fat,tissue glue,gelfoam,and duraseal layer by layer.The patient recovered well,and the computed tomography images showed resolution of the pneumocephalus.CONCLUSION This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.

Pneumocephalus in an advanced aged woman

Pneumocephalus is an uncommon, often forgotten complication of meningitis caused by gas-producing organisms, especially in advanced aged patients. Attention should be paid to physical signs, and early computed tomography （CT） scan could be helpful in the diagnosis. Accurate antibiotics according to blood culture would be the key point in the treatment procedure.

ABC/2 formula for"bedside"postoperative pneumocephalus volume measurement

Background:Postoperative pneumocephalus is associated with a higher risk of recurrence of chronic subdural hematoma(cSDH).However,there is no verified simple way to measure the pneumocephalus volume at the bedside for daily clinical use.The ABC/2 method was shown to be a simple and reliable technique to estimate volumes of intracranial lesions,such as intracranial hematomas.This study aims to evaluate the accuracy of the ABC/2 formula in estimating volumes of pneumocephalus,as compared to the gold standard with computer-assisted volumetric analysis.Methods:A total of 141 postoperative computed tomographic(CT)brain scans of cSDH patients with burr-hole drainage were analysed.Pneumocephalus volume was measured independently by both the ABC/2 formula and the computer-assisted volumetric measurement.For the computer-assisted measurement,the volume of the air was semiautomatically segmented and calculated by computer software.Linear regression was used to determine the correlation between the ABC/2 method and computer-assisted measurement.Results:The postoperative pneumocephalus volume after bilateral burr-hole drainage was significantly larger than that of unilateral burr-hole drainage(29.34 ml versus 12.21 ml,p<0.001).The estimated volumes by the formula ABC/2 significantly correlated to the volumes as measured by the computer-assisted volumetric technique,with r=0.992(p<0.001).The Pearson correlation coefficient is very close to 1,which signifies a very strong positive correlation,and it is statistically significant.Conclusions:An excellent correlation is observed between the ABC/2 method and the computer-assisted measurement.This study verified that the ABC/2 method is an accurate and simple"bedside"technique to estimate pneumocephalus volume.

A case report of diffuse pneumocephalus induced by sneezing after brain trauma

Pneumocephalus is the presence of air in the cranial vault. The common etiologies of pneumocephalus are brain trauma and cranial surgery. We report a case of a 26-year-old man with brain trauma who developed diffuse pneumocephalus after sneezing. CT scan was performed on arrival, and the image showed subarach- noid hemolxhage without pneumocephalus. On the seventh day after a big sneeze brain CT scan was re-performed, which showed pneumocephalus. After another ten days of treatment, the patient was discharged without any symptoms.

Endocranial Complications of Endoscopic Sinus Surgery: Learning from Experience

Objectives: We critically reviewed our experiences in endocranial complications with Functional Endoscopic Sinus Surgery, and investigated the causes, prevention strategies and management. Methods: We conducted a retrospective study of endocranial complications with Functional Endoscopic Sinus Surgery performed during last 10 years in our ENT department. We analyzed endocranial complications, their causes, consequences, treatments and outcomes. Management was performed in collaboration with neurosurgeons and infectious diseases specialists. Results: Of 763 Functional Endoscopic Sinus Surgery procedures, we identified three cases with endocranial complications (0.393%). These complications included: a case of postoperative severe cerebrospinal fluid leak in a patient treated for severe polyposis;a case of cerebral-frontal abscess with delayed clinical manifestation (4 weeks post-surgery) in a patient treated for chronic pansinusitis who experienced difficult surgery for septal spur;and a case of pneumocephalus in a patient treated for allergic fungal sinusitis. The clinical outcome was favorable in all cases. Conclusions: Intra-operative cerebrospinal fluid leak, anatomical deformities (even minimal deformities) and massive inflammatory sinus disease are predisposing factors for endocranial complications with Functional Endoscopic Sinus Surgery. Prognosis can be favorable when therapeutic management is carried out in collaboration with neurosurgeons and infectious disease specialists.