Cases reported "Pneumocephalus"

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1/18. The perils of a sneeze.

    A 51-year-old woman had a 3-day history of severe left supraorbital pain associated with blurred vision of the left eye. Examination revealed visual acuity of 20/20 OD and 20/100 OS. A left relative afferent pupillary defect was present. neuroimaging revealed a large intra-, supra-, and parasellar mass that had eroded through the sphenoid sinus into the maxillary sinus. Secondary pneumocephalus was present. Pathologic examination of the tissue revealed a pituitary adenoma of the null cell type. To the best of our knowledge, there is only one other case in the literature in which a spontaneous pneumatocele represents the initial manifestation of a pituitary adenoma.
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ranking = 1
keywords = sella
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2/18. Spontaneous pneumoventriculogram following radiation of a pituitary adenoma.

    Three years after radiation therapy for an intrasellar tumor, a 42-year-old housewife presented with headache, lethargy, and remarkable plain skull roentgenograms, in which dilated lateral and third ventricles were filled with air. air apparently had entered the cranium through the sphenoid sinus and eroded sellar floor, extending directly through intrasellar remnants of the chromophobe adenoma and into the floor of the third ventricle. Frontal exploration showed an empty sella turcica and no residual tumor. She made an excellent recovery and has done well for 5 years after operative closure of the defect.
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ranking = 39.554274414901
keywords = sella turcica, turcica, sella
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3/18. A rare clival and sellar fracture with pneumatocephalus.

    We present a case of clival and sellar complex fracture produced by an indirect mechanism. This previously healthy patient had an occipital trauma followed by epistaxis. CT showed a clival and sellar fracture with pneumatocephalus. The probable fracture mechanism was contre-coup injury, linked to cerebral shock-wave transmission. This type of fracture is generally observed in the anterior part of the skull base, in a low resistance area. Severe osteoporosis probably accounted for the unusual fracture site in this patient. A mechanism of direct clival transmission is discussed, together with the usual complications of sphenoid injuries.
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ranking = 6
keywords = sella
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4/18. Chronic subdural hematoma after transsphenoidal surgery.

    Chronic subdural haematoma has not been reported as a complication of transsphenoidal surgery. We present a case of pituitary adenoma which was gross-totally removed by transsphenoidal surgery with the enlarged sellar opening. Postoperative serial imaging showed massive air accumulation in both frontal subdural spaces followed by subdural fluid collection and subsequent chronic subdural haematomas 2 months later. We conclude that close follow up imaging study is required to avoid overlooking chronic subdural haematoma when massive air is introduced into the subdural space by the transsphenoidal surgery.
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ranking = 1
keywords = sella
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5/18. Tension pneumocyst after transsphenoidal surgery for Rathke's cleft cyst: case report.

    OBJECTIVE AND IMPORTANCE: Tension pneumocephalus is a rare but well-described complication of transsphenoidal surgery. It is usually associated with postoperative cerebrospinal fluid fistulae causing lower intracranial pressure, with air located in the subdural, subarachnoid, or intraventricular space. We report a case of suprasellar tension pneumocyst that caused visual deterioration to develop after an operation for a Rathke's cleft cyst. Only one similar case has been reported previously. CLINICAL PRESENTATION: A 54-year-old woman with a cystic sellar-suprasellar mass compressing the chiasm was operated on via a standard transsphenoidal approach. The intraoperative diagnosis was Rathke's cleft cyst, and the floor of sella was left open to avoid recurrence. The sphenoid sinus was filled with a fat graft, and the rostrum of the sphenoid was reconstructed with a bone fragment. The patient's postoperative course was uneventful, and her vision improved. Ten days after discharge, the patient was readmitted to the emergency service with headache and visual impairment. Emergent computed tomography confirmed a suprasellar tension pneumocyst. INTERVENTION: The patient underwent immediate reoperation via an endonasal endoscopic approach. After the trapped air was evacuated, the sella was closed with fascia lata and muscle using fibrin glue. The patient's vision improved postoperatively. CONCLUSION: Suprasellar tension pneumocyst is an extremely rare complication of transsphenoidal surgery. To avoid this complication, the sellar floor should be repaired in a watertight fashion, and patients should be instructed to avoid blowing the nose, sneezing, straining, and coughing postoperatively.
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ranking = 8
keywords = sella
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6/18. 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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ranking = 8
keywords = sella
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7/18. Complications of interstitial radioactive iodine implants for recurrent pituitary adenomas.

    Three cases of recurrent pituitary adenoma elected to be treated with I125 implants are presented. The I125 implants caused significant delayed changes in the tissues surrounding the sella turcica which lead to the development of refractory cerebrospinal fluid (CSF) rhinorrhea. All three cases developed meningitis and two had pneumocephalus. This complication lead to the death of two patients and required intensive therapy in the third to achieve recovery.
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ranking = 36.554274414901
keywords = sella turcica, turcica, sella
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8/18. Repair of intractable cerebrospinal fluid rhinorrhea with mucosal flaps and recombinant human basic fibroblast growth factor: technical case report.

    OBJECTIVE AND IMPORTANCE: Repair of a cerebrospinal fluid leak is not always easy, especially when a large fistula, with concomitant infection and injured mucosa, has developed from repeated transsphenoidal operations. We repaired such a sellar floor defect with mucosal flaps via the endonasal endoscopic approach and finally obliterated the fistula by promoting granulation-like tissue formation with recombinant human basic fibroblast growth factor (bFGF). CLINICAL PRESENTATION: A 27-year-old woman with intractable cerebrospinal fluid rhinorrhea was referred to our department after repeated operations for a relapsing Rathke's cleft cyst. Endonasal endoscopic examination revealed a large bone defect on the sellar floor through which previously packed fat and fascia were exposed to the nasal cavity. INTERVENTION: Mucosal flaps were harvested endoscopically from the nasal septum and the superior and middle turbinates. These pedicled flaps were transposed to the sellar defect. The flaps survived but did not cover the whole area, resulting in gaps between the flaps through which cerebrospinal fluid still leaked. Recombinant bFGF was repeatedly applied endoscopically to the mucosal flaps. The flaps turned into granulation-like tissue, and complete mucosal covering was finally achieved. CONCLUSION: bFGF has a wide range of biological effects, including stimulation of fibroblast growth and promotion of angiogenesis. It accelerates wound healing and is used clinically to treat dermal ulcers. The method presented here to treat an intractable fistula with mucosal flap and recombinant bFGF may suggest a new clinical application of bFGF. This possibility should be examined in a large number of patients in the future.
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ranking = 3
keywords = sella
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9/18. Endoscopic decompression of tension pneumosella following transsphenoidal pituitary tumor resection.

    OBJECTIVE AND IMPORTANCE: Tension pneumosella is an extremely rare complication of transsphenoidal surgery, having been reported only three times previously. patients who develop this expanding pneumocele confined to the sella present with visual field changes consistent with optic chiasm compression. If left untreated, this condition can lead to permanent visual deficits. We report a case of tension pneumosella after transsphenoidal resection of a benign pituitary adenoma that was successfully treated endoscopically. CLINICAL PRESENTATION: Six months after transsphenoidal resection of a pituitary tumor, a 70-year-old man presented with subjective vision loss and was found on formal testing to have bitemporal hemianopsia. A diagnosis of tension pneumosella was made with a head CT after tumor recurrence was ruled out with MRI. The expanding pneumocele developed after vigorous nose blowing in the setting of a surgical sellar floor defect and an intact diaphragma sellae. INTERVENTION: The pneumocele was endoscopically decompressed using a transnasal approach guided by frameless stereotaxy. An immediate decrease in the amount of air was confirmed with intraoperative fluoroscopy. The defect was subsequently repaired with a hemostatic agent and fibrin glue. The patient rapidly recovered his vision and went home on postoperative day one with no further visual complications. CONCLUSION: Tension pneumosella should be considered as a possible diagnosis in patients presenting with subacute visual field deficits after transsphenoidal pituitary region surgery. endoscopy may play a valuable role in the diagnosis and management of this rare phenomenon, as well as other more common complications of transsphenoidal surgery.
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ranking = 11
keywords = sella
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10/18. Traumatic bilateral abducent nerve palsies.

    A patient sustained a severe cranio-facial injury which included a transverse fracture of the middle cranial fossa through the sella turcica producing otorrhoea, rhinorrhoea, a bilateral abducents palsy and a large aero-coele. All gradually remitted spontaneously. The management of this patient and the patterns of cranial base fractures and their associated clinical features, particularly of the middle cranial fossa, are discussed.
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ranking = 36.554274414901
keywords = sella turcica, turcica, sella
(Clic here for more details about this article)
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