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Cerebral complications after unilateral biportal endoscopic surgery: A case report
Chao Han1, Zhan-Yun Ren2, Zhen-Huan Jiang3
1Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China. staff940@yxph.com.
Background:
Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.
Case Summary:
A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.
Conclusion:
Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.
