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Updated: Oct 24, 2025
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
19.1K
Delayed CPAP-Induced Pneumocephalus and Meningitis Posttranssphenoidal Surgery
Tara D'Ignazio1, Mary Francispillai1, Marc Giroux2
1Service des Soins Intensifs, Hôpital du Sacré-Coeur de Montréal, Département de Médecine, Université de Montréal, Montréal, Canada.
Case Reports in Critical Care
|August 16, 2021
Summary
Transsphenoidal surgery patients with obstructive sleep apnea (OSA) who need positive pressure ventilation may face rare pneumocephalus complications. This case highlights a delayed pneumocephalus presentation five weeks after CPAP use, questioning current reintroduction guidelines.
Area of Science:
- Neurosurgery
- Pulmonology
- Sleep Medicine
Background:
- Transsphenoidal surgery (TSS) is a common pituitary adenoma treatment.
- Obstructive sleep apnea (OSA) frequently co-occurs in patients undergoing TSS, necessitating positive pressure ventilation.
- Postoperative pneumocephalus is a rare but serious complication of TSS.
Observation:
- A 69-year-old female developed pneumocephalus five weeks after TSS for a pituitary adenoma.
- The complication arose after reintroduction of her CPAP machine for OSA management.
- This represents the latest documented onset of pneumocephalus following CPAP reintroduction post-TSS.
Findings:
- The case suggests that the typical 2-4 week postoperative CPAP reintroduction window may be insufficient for some TSS patients with OSA.
- Delayed pneumocephalus can occur significantly later than commonly assumed.
Implications:
- Re-evaluating the recommended waiting period for CPAP use after TSS in OSA patients is warranted.
- Further research is needed to establish safer guidelines for positive pressure ventilation management post-TSS.
- This case underscores the importance of vigilance for rare complications even after the initial recovery period.
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