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Diffuse symptomatic pneumocephalus after biportal endoscopic spinal surgery: illustrative case
Chien-Tung Yang1,2, Cheng-Di Chiu3,2, Chih-Ying Wu4,5
1School of Medicine, Kaoshiung Medical University, Kaoshiung, Taiwan.
A rare complication of pneumocephalus (air in the brain) can occur after minimally invasive endoscopic lumbar decompression surgery. Vacuum drain placement is a potential risk factor for this condition.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
Background:
- Percutaneous endoscopic lumbar decompression is an emerging minimally invasive surgical technique.
- Biportal endoscopic spinal surgery (BESS) is utilized for treating lumbar stenosis.
Observation:
- A case of pneumocephalus following BESS for lumbar stenosis is presented.
- A 79-year-old female patient developed intracranial hypotension symptoms post-surgery.
- Cerebrospinal fluid drainage and brain CT confirmed pneumocephalus.
Findings:
- No intraoperative dural tear was identified.
- Vacuum drain placement was a key factor in the complication.
- Conservative management (bed rest, hydration) led to symptom resolution and CT-confirmed pneumocephalus resolution.
Implications:
- Pneumocephalus is a rare but significant complication of endoscopic lumbar surgery.
- Risk factors include potential dural tears, extensive saline irrigation, and vacuum drain use.
- Awareness of these risk factors is crucial for preventing and managing this complication.
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