FOLLOW-UP AND TREATMENT OF PNEUMOCEPHALUS WITH REGRESSION OF CONSCIOUSNESS AFTER LUMBAR SURGERY: CASE REPORT

Yıl 2024, Cilt: 9 Sayı: 1, 37 - 41, 31.05.2024

Emin Çağıl , Bekir Tunç

Öz

Pneumocephalus is the presence of air in the brain parenchyma. It is most commonly seen after head traumas. Causes of spinal pneumocephalus include trauma, penetrating injuries, tumors, infections and iatrogenic causes such as lumbar puncture and laparoscopic biopsy. Unintentional durotomy and cerebrospinal fluid (CSF) leakage during spinal surgery is a well-known and common complication and pneumocephalus is one of the rare complications that may occur. In this article, we present a patient who underwent decompression+ fusion surgery with a diagnosis of lumbar narrow canal, who regressed in consciousness and was treated and followed up after 9 days of follow-up.

Anahtar Kelimeler

Lumbar duratomy, Lumbar stenosis, Pneumocephalus, Unconsciousness

Lomber Cerrahi Sonrası Bilinçte Gerileme Yapan Pnomosefali Takip ve Tedavisi: Olgu Sunumu

Öz

Pnömosefali beyin parankim dokusu içerisinde hava bulunmasıdır. En sık kafa travmaları sonrası görülür. Spinal pnömosefali nedenleri arasında travmalar, penetran yaralanmalar, tümörler, enfeksiyonlar ile lomber ponksiyon ve laparoskopik biyopsi gibi iyatrojenik nedenler yer almaktadır. Spinal cerrahi esnasında istem dışı durotomi meydana gelmesi ve beyin omurilik sıvısı (BOS) kaçağı olması iyi bilinen, sıkça karşılaşılabilen komplikasyondur ve buna bağlı olarak pnömosefali görülebilecek nadir komplikasyonlardandır. Bu yazıda lomber dar kanal tanısı ile dekompresyon+ füzyon cerrahisi yapılan hastada bilinçte gerileme yapıp, 9 günlük takip sonrası tedavi ve izlemi yapılan hastamızı sunduk.

Anahtar Kelimeler

Pnömosefali, Bilinç Kaybı, Lomber dar kanal, Lomber duratomi

Etik Beyan

Hastadan aydınlatılmış onam alınmıştır.

Kaynakça

• Avellanal, M., Olmedilla, L., Ojea, R., Rueda, M. L., & Navia, J. (1996). Pneumocephalus after spinal anesthesia. Anesthesiology, 85(2), 423–425. https://doi.org/10.1097/00000542-199608000-00026
• Ayberk, G., Yaman, M. E., & Ozveren, M. F. (2010). Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia, 17(7), 934–936. https://doi.org/10.1016/j.jocn.2009.10.033
• Bosacco, S. J., Gardner, M. J., & Guille, J. T. (2001). Evaluation and treatment of dural tears in lumbar spine surgery: A review. Clinical Orthopaedics and Related Research, 389, 238–247. https://doi.org/10.1097/00003086-200108000-00033
• Cihangiroğlu, M., Unal, B., Ozdemir, H., Yildirim, H., & Oğur, E. (2003). [Pictorial essay: Pneumocephalus]. Tanisal Ve Girisimsel Radyoloji: Tibbi Goruntuleme Ve Girisimsel Radyoloji Dernegi Yayin Organi, 9(1), 31–35.
• Eismont, F. J., Wiesel, S. W., & Rothman, R. H. (1981). Treatment of dural tears associated with spinal surgery. The Journal of Bone and Joint Surgery. American Volume, 63(7), 1132–1136.
• Eltorai, I. M., Montroy, R. E., Kaplan, S. L., & Ho, W. H. (2003). Pneumocephalus secondary to cerebrospinal fluid leak associated with a lumbar pressure ulcer in a man with paraplegia. The Journal of Spinal Cord Medicine, 26(3), 262–269. https://doi.org/10.1080/10790268.2003.11753695
• Kozikowski, G. P., & Cohen, S. P. (2004). Lumbar puncture associated with pneumocephalus: Report of a case. Anesthesia and Analgesia, 98(2), 524–526. https://doi.org/10.1213/01.ANE.0000095153.75625.1F
• Lunsford, L. D., Maroon, J. C., Sheptak, P. E., & Albin, M. S. (1979). Subdural tension pneumocephalus. Report of two cases. Journal of Neurosurgery, 50(4), 525–527. https://doi.org/10.3171/jns.1979.50.4.0525
• Nafiu, O. O., & Urquhart, J. C. (2006). Pneumocephalus with headache complicating labour epidural analgesia: Should we still be using air? International Journal of Obstetric Anesthesia, 15(3), 237–239. https://doi.org/10.1016/j.ijoa.2005.10.011
• Osborn, A. G., Daines, J. H., Wing, S. D., & Anderson, R. E. (1978). Intracranial air on computerized tomography. Journal of Neurosurgery, 48(3), 355–359. https://doi.org/10.3171/jns.1978.48.3.0355
• Reasoner, D. K., Todd, M. M., Scamman, F. L., & Warner, D. S. (1994). The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology,80(5), 1008–1012. https://doi.org/10.1097/00000542-199405000-00009
• Ricchiuti, V. S., & Seftel, A. D. (2001). Iatrogenic pneumocephalus after laparoscopic renal biopsy. The Journal of Urology, 166(3), 982–983.
• Uppot, R. N., Gheyi, V. K., Gould, S. W., & Ito, H. (1999). Pneumocephalus and Brown-Séquard’s Neurologic injury caused by a stab wound to the neck. AJR. American Journal of Roentgenology, 173(6), 1504. https://doi.org/10.2214/ajr.173.6.10584791