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  • Title: [Intracranial pneumocephalus under pressure. A possible cause of postoperative deterioration in neurosurgery. 10 cases].
    Author: Bret P, Kzaiz M, Guyotat J, Fischer G, Zannini C.
    Journal: Neurochirurgie; 1987; 33(3):209-15. PubMed ID: 3614496.
    Abstract:
    10 patients in whom an early post operative alteration of the level of consciousness or of the neurological status could be related to a tension pneumocephalus are reviewed. Four underwent a surgical procedure in the sitting position. Among these, 2 had been previously shunted for hydrocephalus. A 5th patient underwent a IIId ventriculocisternostomy for tumorous occlusion of the aqueduct. The other five patients were involved with supra-tentorial conditions (hemispheric glioma: 1 case, meningioma: 1 case, chronic subdural hematoma: 3 cases). The post-operative deterioration clinically suggested a post operative hematoma. CT showed a very low density effusion either located in the operative area or in the subdural space or both, with significant mass effect. 9 patients steadily improved after conservative therapy. In 1 case, reoperation was required. Pathogenesis of symptomatic pneumocephalus remains controversial. The role of the sitting position and of CSF drainage seem likely. Spontaneous or nitrous oxide induced expansion of post-operative residual intra cranial air plays a debatable role. It is postulated that tension pneumocephalus may result from a discrepancy between spontaneous reexpansion of the cerebral mass and a residual air collection. Such complications are regarded as serious enough to justify several preventive measures.
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