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Published on: February 29, 2020
Seizure as Early Presentation of a Pneumocephalus after Cochlear Implant: A Case Report
José María Palacios-García1, Elena Vazquez-Becerra1, Francisco Ropero-Romero1
1Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain.
Insights
Pneumocephalus, a rare complication of cochlear implantation, can present with immediate neurological symptoms like seizures. Conservative management is often effective for this condition, which may arise from bone defects.
Area of Science:
- Neurosurgery
- Otolaryngology
- Medical Imaging
Background:
- Cochlear implantation is a common surgical procedure for hearing loss.
- Pneumocephalus, the presence of air within the cranial cavity, is an exceptionally rare complication following cochlear implantation.
- Clinical manifestations of pneumocephalus typically appear weeks post-surgery, making immediate postoperative presentation highly unusual.
Observation:
- A 35-year-old male experienced seizures within hours of cochlear implantation surgery.
- Computed tomography (CT) revealed pneumocephalus and an undetected bone defect along the electrode's drilling path.
- The patient's neurological symptoms emerged unusually early in the postoperative period.
Findings:
- The case highlights the potential for immediate neurological complications from pneumocephalus after cochlear implantation.
- Conservative management, including clinical observation and serial imaging, led to the reabsorption of pneumocephalus.
- Early detection and appropriate management are crucial for potentially life-threatening neurological manifestations.
Implications:
- Cochlear implant surgeons should consider pneumocephalus in the differential diagnosis of postoperative neurological deficits, particularly if intraoperative bone defects are suspected.
- Conservative management is generally effective for pneumocephalus, with surgical intervention reserved for severe or tension cases.
- This case underscores the importance of vigilance for rare but serious complications in the immediate postoperative period following cochlear implantation.
Abstract:
Pneumocephalus after cochlear implantation is very rare with five reported cases in the literature. The presence of clinical features in the immediate postoperative period has never been reported, because they occur weeks after surgery. These neurological manifestations can compromise the patient's life; thus, it is important to have proper knowledge and management of these manifestations. We present a case report with a review of the literature. A 35-year-old man began having seizures a few hours after a cochlear implantation. Computed tomography (CT) scan revealed a pneumocephalus and bone defect at the level of the electrode's drilling path, not objected during the surgery. The patient was handled conservatively, and in subsequent reviews, CT objected reabsorption of the pneumocephalus. The presence of a pneumocephalus should be taken into account in the neurological features of a patient with cochlear implant, especially if mastoid bone defects are suspected during surgery. The management of the pneumocephalus will, in most cases, be conservative, consisting of clinical observation and imaging tests. Surgical treatment is reserved for situations in which the clinical manifestations are very symptomatic and when they are tension pneumocephalus.
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