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Subdural tension pneumocephalus following surgery
Journal of Computer Assisted Tomography
|October 1, 1982
Summary
Subdural pneumocephalus can cause significant mass effect when air volume exceeds 65 cm3, potentially shifting midline structures. Asymptomatic cases typically involve less than 20 cm3 of air.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Subdural pneumocephalus, the presence of air in the subdural space, can occur postoperatively.
- Distinguishing between symptomatic (tension) and asymptomatic pneumocephalus is crucial for patient management.
Observation:
- A clinical computed tomographic (CT) study analyzed six patients with subdural pneumocephalus (two tension, four benign).
- Mass effect, indicated by midline shift, was observed in tension pneumocephalus but not in asymptomatic cases.
- Literature review of 21 postsurgical tension pneumocephalus cases revealed 86% occurred in the subdural space.
Findings:
- Air volume estimation using CT scans differentiated symptomatic (>65 cm3) from asymptomatic (<20 cm3) pneumocephalus.
- Predisposing factors for tension pneumocephalus include open cerebrospinal fluid drainage, posterior fossa surgery in the sitting position, and chronic subdural hematoma.
Implications:
- CT volume estimation aids in assessing the severity and clinical significance of subdural pneumocephalus.
- Identifying predisposing factors can help neurosurgeons anticipate and potentially prevent tension pneumocephalus.