Pneumocephalus: Case Illustrations and Review

• Published in: Neurocritical care Vol. 13; no. 1; pp. 152 - 158
• Main Authors: Schirmer, Clemens M., Heilman, Carl B., Bhardwaj, Anish
• Format: Journal Article
• Language: English
• Published: New York Humana Press Inc 01.08.2010; Springer Nature B.V
• Subjects: Adenoma - surgery; Adipose Tissue - transplantation; Aged; Arnold-Chiari Malformation - diagnostic imaging; Arnold-Chiari Malformation - surgery; Autopsies; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - surgery; Child; Chronic Disease; Critical Care Medicine; Diagnosis, Differential; Diagnostic tests; Endoscopy; Epidural; Etiology; Fractures; Headaches; Hematoma; Hematoma, Subdural - diagnostic imaging; Hematoma, Subdural - surgery; Humans; Infections; Intensive; Internal Medicine; Male; Medical imaging; Medicine; Medicine & Public Health; Meningitis; Middle Aged; Neurology; Neurosurgical Procedures - adverse effects; Otolaryngology; Patients; Pituitary Neoplasms - surgery; Pneumocephalus - diagnostic imaging; Pneumocephalus - etiology; Pneumocephalus - surgery; Reconstructive Surgical Procedures; Review Article; Sinuses; Skull Base Neoplasms - diagnostic imaging; Skull Base Neoplasms - surgery; Surgery; Tomography, X-Ray Computed; Trauma; Tumors; Mount Fuji; Mount Fuji sign; Nitrous oxide; Air bubble sign; Pneumocephalus; Postsurgical
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-010-9363-0

Background Pneumocephalus is commonly encountered after neurosurgical procedures but can also be caused by craniofacial trauma and tumors of the skull base and rarely, can occur spontaneously. Contributing factors for the development of pneumocephalus include head position, duration of surgery, nitrous oxide (N 2 O) anesthesia, hydrocephalus, intraoperative osmotherapy, hyperventilation, spinal anesthesia, barotauma, continuous CSF drainage via lumbar drain, epidural anesthesia, infections, and neoplasms. Clinical presentation includes headaches, nausea and vomiting, seizures, dizziness, and depressed neurological status. In this article, we review the incidence, mechanisms, precipitating factors, diagnosis, and management of pneumocephalus. Search of Medline, databases, and manual review of article bibliographies. Considering four case illustrations that typify pneumocephalus in clinical practice, we discuss the common etiologies, and confirm the diagnosis with neuroimaging and management strategies. Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity. A significant amount of pneumocephalus can simulate a space-occupying lesion. Supplemental oxygen increases the rate of absorption of pneumocephalus.