Document Detail

Tension pneumocephalus as a complication of lumbar drainage for cerebral aneurysm surgery--case report.
MedLine Citation:
PMID:  19556734     Owner:  NLM     Status:  MEDLINE    
A 66-year-old man developed tension pneumocephalus after failed lumbar drainage before clipping surgery for a ruptured anterior communicating artery aneurysm. After puncture with a Tuohy needle, the spinal catheter could not be inserted into the spinal dura, so surgery proceeded without the catheter placement. The patient's neurological status deteriorated suddenly into coma within 15 hours after uneventful clipping of the aneurysm. Computed tomography revealed tension pneumocephalus with marked brain shift. Intracranial hypotension was probably caused by continuous cerebrospinal fluid leakage from the iatrogenic spinal dural tear, resulting in air entry and accumulation into the cranium from an unidentified opening of the cranial dura. The patient was immediately treated with autologous epidural blood patch administration in the lumbar spine, followed by reopening of the craniotomy incision and flap to evacuate the accumulated air. The patient made a quick and uneventful neurological recovery after the rescue procedure.
Katsuya Saito; Joji Inamasu; Takumi Kuramae; Masashi Nakatsukasa; Fumio Kawamura
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurologia medico-chirurgica     Volume:  49     ISSN:  1349-8029     ISO Abbreviation:  Neurol. Med. Chir. (Tokyo)     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-26     Completed Date:  2009-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400775     Medline TA:  Neurol Med Chir (Tokyo)     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  252-4     Citation Subset:  IM    
Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.
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MeSH Terms
Blood Patch, Epidural
Brain / blood supply,  physiopathology,  radiography
Catheters, Indwelling / adverse effects
Cerebrospinal Fluid Pressure / physiology
Coma / etiology,  physiopathology
Disease Progression
Dura Mater / injuries*,  physiopathology,  radiography
Hernia / etiology,  physiopathology,  radiography
Iatrogenic Disease / prevention & control
Intracranial Aneurysm / physiopathology,  surgery*
Intracranial Hypotension / complications,  physiopathology
Needles / adverse effects
Pneumocephalus / etiology*,  physiopathology,  radiography
Postoperative Complications / etiology*,  physiopathology,  radiography
Preoperative Care / adverse effects*
Spinal Puncture / adverse effects*
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures

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