Cases reported "Pneumocephalus"

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1/11. Progressive visual loss because of a suprasellar pneumatocele after trans-sphenoidal resection of a pituitary adenoma.

    A 63-year-old man who underwent uneventful trans-sphenoidal resection of a pituitary adenoma with fat packing complained postoperatively of progressive binocular visual acuity loss. neuroimaging showed a suprasellar pneumatocele compressing the optic chiasm and a communication between the sphenoid sinus and the sella. After a second trans-sphenoidal procedure to remove the air and fully pack the sphenoid sinus, visual acuity recovered dramatically. A rare complication of trans-sphenoidal surgery for pituitary adenoma, suprasellar pneumatocele probably forms through a ball-valve mechanism that results from incomplete packing of the sellar floor. This case highlights the need for effective sphenoid sinus packing and for ophthalmic monitoring after trans-sphenoidal surgery.
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2/11. Atypical headache after prolonged treatment with nasal continuous positive airway pressure.

    We report a case of atraumatic pneumocephalus associated with prolonged use of nasal continuous positive airway pressure. Initial symptoms included headache, ataxia, vertigo, and a "gurgling" sensation in the head; and a CT image showed small air bubbles along the falx of cerebrum and adjacent to the temporal epidural spaces bilaterally. Although no evidence of cerebrospinal fluid (CSF) leak was either reported by the patient or found at initial clinical examination, subsequent nasal discharge tested positive for beta2-transferrin, a finding consistent with CSF leak in the paranasal sinus region or through the cribriform plate. To try to prevent infection from an open communication between the paranasal sinuses and intracranial structures, an attempt should be made to localize the anatomic defect.
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3/11. frontal sinus osteoma with complicating intracranial aerocele.

    An elderly man, who presented initially with clinical features of dementia, was found to have an intracranial tension aerocele due to an underlying osteoma of the frontal sinus. Plain skull roentgenograms and computerized tomography did not reveal the osteoma, although a communication between the frontal sinus and the aerocele was present. Surgical aspiration of the aerocele and excision of the osteoma produced an excellent clinical result.
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4/11. pneumocephalus secondary to tension pneumothorax associated with comminuted fracture of the thoracic spine.

    We present an unusual case of pneumocephalus secondary to a tension pneumothorax associated with fracture of the thoracic spine. Air from a pneumothorax entered the thoracic intraspinal compartment and the intracranial cavity through a comminuted fracture of the spine. The pneumocephalus and the pneumothorax resolved after aspiration of the intrathoracic air via an intercostal catheter. diagnosis, therapeutic modalities, and potential complications of a pneumocephalus and of a communication between the thoracic cavity and the spinal dural space are discussed.
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5/11. Tension pneumocephalus.

    Tension pneumocephalus occurs when intracranial air exists under pressure, resulting in neurologic deterioration. The syndrome is precluded by an extracranial-intracranial communication and a difference in extracranial-intracranial pressure with the latter being greater. Although most frequently associated with head trauma, a variety of situations, including an operative sitting position and use of nitrous oxide anesthesia, have been known to contribute to this potentially life-threatening complication. This article will address pathogenesis, assessment parameters, and medical and nursing approaches utilized to reduce and minimize further entrapment of air. A case report will be presented illustrating this condition.
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6/11. Gas within intracranial abscess cavities: an indication for surgical excision.

    Five patients were treated in whom gas within an intracranial abscess cavity was identified by plain roentgenogram, computed tomographic scan, or both. Management by aspiration in three patients was unsuccessful. Total excision of the abscess cavity was eventually required in all five patients, and a persistent extracranial communication was identified and closed in each. One patient died secondary to transtentorial herniation and severe brainstem injury; the other four recovered fully. Although certain anaerobic organisms may produce gas in the absence of a communication to the outside of the body, such production is uncommon. Total surgical excision is recommended for gas-containing abscesses because it allows removal of the mass lesion and identification and closure of possible persistent extracorporal communication.
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7/11. pneumocephalus secondary to spontaneous bronchial-subarachnoid fistula.

    We describe a patient in whom pneumocephalus appeared spontaneously, resulting from a communication between the bronchial tree and the thoracic subarachnoid space in association with squamous cell carcinoma of the lung. The communication was demonstrated by myelography and obliterated surgically. A review of the literature is included.
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8/11. Intraventricular pneumocephalus after posterior fossa and CSF shunting surgery. Case report.

    The authors report a case of tension intraventricular pneumocephalus developed six months after the removal of an acoustic neuroma and a CSF ventriculoperitoneal shunt procedure due to a concomitant hydrocephalus. A review of the literature show only 19 cases of CSF shunt complicating pneumocephalus. The authors discuss both about the etiology of pneumocephalus and its therapeutic options. In our case we were unable to preoperatively localize the cranial base communication allowing intracranial air antry. The literature show however that eroded or thinned bone areas may be multiple and even diffuse their development depending upon several factors. We suggest in these cases a direct surgical repair through a craniotomy, as reported by others, is not mandatory. According to the etiology of pneumocephalus a temporary extraventricular drainage and the revision of the shunting pressure regimen may represent an effective treatment of this complication.
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9/11. Spontaneous CSF communication to the middle ear and external auditory canal. A case report.

    A 27-year-old female with no history of trauma, surgery, infection, or neoplastic process was evaluated for the spontaneous onset of vomiting, headache, and loss of balance. Initial studies demonstrated extensive pneumocephalus. CT revealed a lytic, expansile defect of the right petrous bone, while intrathecal contrast images demonstrated flow of CSF that implied coincidental perforation of the tympanic membrane. MR imaging demonstrated a continuity of CSF signal. The patient underwent surgery to repair the CSF leak and a dural patch was applied. No symptoms of pneumocephalus were seen after surgery and the patient's condition improved.
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10/11. The "temporocele".

    This article reports a case of spontaneous extracranial pneumatocele and introduces a new simple terminology for this clinical entity. A 10-year-old Saudi girl presented with left tympanoparietomastoid swelling. It was found to be fluctuant and full of air. On exploration, bony septae were found arising from the skull aponeurosis, the cranial boundary was elevated, and an ivory, cancellous bony swelling was over the root of the zygoma. No naked eye anatomic communication to the mastoid air cell was found. The mastoid pneumatization was within normal limits. All preoperative, operative, and postoperative investigations are presented. The authors introduce temporocele as a new term applied to this extracranial spontaneous pneumatocele.
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