Vol 51, No 4 (2017)

open access

Page views 291
Article views/downloads 543
Get Citation

Connect on Social Media

Connect on Social Media

Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population

P. Daszkiewicz1, D. Dziedzic2
DOI: 10.1016/j.pjnns.2017.04.006
Neurol Neurochir Pol 2017;51(4):286-289.



Sitting craniotomy often results in entrapment of air in fluid-filled intracranial cavities. Gas under pressure exerts a deleterious effect on adjacent nervous tissue, resulting in clinical deterioration.

Aim of study

To assess the incidence of tension pneumocephalus (TP) and to define risk factors associated therewith.

Material and method

Analysis included 100 consecutive patients (57 boys, 43 girls, mean age 9.7 y) undergoing suboccipital sitting craniotomy since 2012 to 2014.


In our material (n=100) TP was seen in 7 cases, asymptomatic pneumocephalus (AP) in 77 and no pneumocephalus (NP) in 16. Tumor types encountered were typical for pediatric population. In the TP group (n=7) the ratio of low-grade to high-grade tumors was 5:2, in the AP group (n=77) 2:1 and in the NP group (n=16) 1:1. Preoperative hydrocephalus was present in 21 cases (21%, mean incidence), thereof 3 in the TP group (3/7; 42.8%), 12 in AP group (12/77; 15.5%) and 6 in the NP group (6/16; 37.5%). All TP patients received an emergency external drainage, thereof 4 required a permanent ventriculo-peritoneal shunt (57.1%), while AP and NP patients combined (n=93) required a permanent shunt in 4 cases only (4.3%). TP-associated morbidity (n=2) consisted in a significant deterioration of neurological condition.


TP is a relatively rare but potentially serious complication of suboccipital sitting craniotomy. Risk factors for TP are low-grade tumor and pre-existing long-standing hydrocephalus. TP requires emergency decompression by temporary external drainage. TP patients significantly more often require a permanent CSF shunt.

Article available in PDF format

View PDF Download PDF file

Neurologia i Neurochirurgia Polska