open access

Vol 51, No 4 (2017)
Original research articles
Submitted: 2015-12-26
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Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population

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

open access

Vol 51, No 4 (2017)
Original research articles
Submitted: 2015-12-26

Abstract

Background

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.

Results

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.

Conclusions

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.

Abstract

Background

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.

Results

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.

Conclusions

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.

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Keywords

Tension pneumocephalus, Sitting craniotomy, Children

About this article
Title

Tension pneumocephalus following suboccipital sitting craniotomy in the pediatric population

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 4 (2017)

Pages

286-289

DOI

10.1016/j.pjnns.2017.04.006

Bibliographic record

Neurol Neurochir Pol 2017;51(4):286-289.

Keywords

Tension pneumocephalus
Sitting craniotomy
Children

Authors

P. Daszkiewicz
D. Dziedzic

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