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Delayed tension pneumocephalus complicating orbital exenteration.

M D Esson1, M Blanco-Guzman, P S Douglas

  • 1Torbay Hospital, Lawes Bridge, Torquay TQ2 7AA, UK. md.esson@virgin.net

The British Journal of Oral & Maxillofacial Surgery
|March 8, 2005
PubMed
Summary

A patient developed air in the brain after lacrimal gland cancer surgery. Conservative treatment led to a full recovery, highlighting a rare but manageable complication of orbital exenteration.

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Area of Science:

  • Ophthalmology
  • Neurosurgery
  • Oncology

Background:

  • Adenoid cystic carcinoma is a rare malignancy affecting the lacrimal gland.
  • Orbital exenteration is a radical surgical procedure involving the removal of orbital contents.
  • Reconstruction following exenteration aims to restore form and function.

Observation:

  • A 43-year-old woman underwent orbital exenteration and reconstruction for recurrent lacrimal gland adenoid cystic carcinoma.
  • Postoperatively, she developed symptoms suggestive of cerebral irritation.
  • Computed tomography revealed the presence of both intracerebral and subarachnoid air.

Findings:

  • The presence of intracranial air (pneumocephalus) is a rare complication following orbital surgery.
  • Cerebral irritation symptoms correlated with the detection of air in the brain and subarachnoid spaces.

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  • The patient's condition resolved without further surgical intervention.

    • Implications:

    • This case highlights a rare complication of orbital exenteration, emphasizing the importance of vigilant postoperative monitoring.
    • Conservative management can be effective for managing post-surgical pneumocephalus in the absence of neurological deficits.
    • Further research into risk factors and preventative strategies for pneumocephalus after orbital surgery is warranted.