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Severe headache following ozone therapy: Pneumocephalus
Hüseyin Toman1, Uğur Özdemir, Hasan Ali Kiraz
1Department of Anesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey. huseyintoman01@hotmail.com.
Summary
A rare complication of pneumocephalus (air in the cranial cavity) occurred after percutaneous epidural neuroplasty in a failed back surgery patient. The condition resolved with conservative treatment, highlighting a potential risk associated with the procedure.
Area of Science:
- Neurology
- Pain Management
- Minimally Invasive Procedures
Background:
- Pneumocephalus, air within the cranial cavity, can arise from dural puncture during procedures like lumbar epidural anesthesia.
- Failed back surgery syndrome presents ongoing pain and functional deficits after spinal surgery.
- Percutaneous epidural neuroplasty is an interventional pain management technique.
Observation:
- A 41-year-old woman with failed back surgery syndrome underwent percutaneous epidural neuroplasty using an oxygen-ozone mixture followed by corticosteroids and hyaluronidase.
- Post-procedure, the patient developed severe headache and nausea, indicative of pneumocephalus.
- Computed tomography confirmed air in the frontal horn of the right lateral ventricle, interhemispheric fissure, and superior cerebellar cistern.
Findings:
- The patient was treated with the Trendelenburg position, intravenous fluids, analgesics, and bed rest.
- Symptoms of pneumocephalus resolved within a week, and the patient was discharged on the second day post-procedure.
- This case highlights the occurrence of pneumocephalus as a complication following epidural neuroplasty.
Implications:
- Clinicians should be aware of pneumocephalus as a potential complication of percutaneous epidural neuroplasty, especially when combined with oxygen-ozone therapy.
- Prompt diagnosis and conservative management, including the Trendelenburg position, can effectively treat pneumocephalus.
- Further research may be warranted to elucidate the exact mechanism and risk factors for pneumocephalus in this context.