Document Detail

The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air.
MedLine Citation:
PMID:  8017640     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pneumocephalus occurs in a variety of clinical settings and has important anesthetic implications, particularly if N2O is used. One common cause of pneumocephalus is a craniotomy or craniectomy, and therefore, patients undergoing these neurosurgical procedures may be at increased risk for the development of tension pneumocephalus if N2O is used during a subsequent anesthetic. However, because the rate at which a postoperative pneumocephalus resolves has not been well defined, the duration of this risk period is unknown. METHODS: Department of Anesthesia billing codes were used to identify all patients undergoing supratentorial craniotomy between 1986 and 1990. This list was cross-indexed with Department of Radiology data to generate a list of patients who had had a computed tomographic scan of the head performed on or after the day of their surgery. From this list, 240 scans were examined for the presence of intracranial air. The magnitude of pneumocephalus, if present, was ranked as large, moderate, small, or trace. RESULTS: Air was seen in all scans obtained in the first 2 post-operative days. Sixty-six percent of these pneumocephali were judged to be moderate or large. The incidence of pneumocephalus decreased to 75% by postoperative day 7. During the 2nd and 3rd postoperative weeks, the incidence of pneumocephalus decreased to 59.6 and 26.3%, respectively. The size of the pneumocephali also decreased. Still, 11.8% of the scans obtained during the 2nd postoperative week had pneumocephali that were judged to be moderate or large. CONCLUSIONS: These data indicate that all patients have pneumocephalus immediately after a supratentorial craniotomy. Although the incidence and size of pneumocephali decrease over time, a significant number of patients have an intracranial air collection large enough to put them at risk for complication if N2O is used during a second anesthetic in the first 3 weeks after the first procedure. This information should be considered in the evaluation of the patient and in the selection of anesthetic agents.
D K Reasoner; M M Todd; F L Scamman; D S Warner
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  80     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  1994 May 
Date Detail:
Created Date:  1994-07-28     Completed Date:  1994-07-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1008-12     Citation Subset:  AIM; IM    
Department of Anesthesia, University of Iowa College of Medicine, Iowa City.
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MeSH Terms
Anesthesia, General / adverse effects*
Craniotomy / adverse effects*
Nitrous Oxide / adverse effects*
Pneumocephalus / epidemiology*
Postoperative Complications / epidemiology*
Retrospective Studies
Time Factors
Tomography, X-Ray Computed*
Reg. No./Substance:
10024-97-2/Nitrous Oxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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