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Symptomatic pneumocephalus after transsphenoidal surgery

R P Haran1, M J Chandy

  • 1Department of Neurosurgery, Christian Medical College and Hospital, Vellore, India.

Surgical Neurology
|December 24, 1997
PubMed
Summary
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Symptomatic pneumocephalus is a rare complication after transsphenoidal surgery. Early repair of the sellar floor and sphenoid sinus is crucial for managing this condition, even after partial tumor excision.

Area of Science:

  • Neurosurgery
  • Endoscopic Skull Base Surgery

Background:

  • Symptomatic pneumocephalus is a rare complication following transsphenoidal surgery for sellar/suprasellar mass lesions.
  • This study presents three cases of pneumocephalus in 300 transsphenoidal operations over 12 years.

Observation:

  • Case 1: Pneumocephalus developed despite sellar floor repair due to CSF drainage via a lumbar subarachnoid drain.
  • Case 2: Pneumocephalus occurred after partial tumor excision and ventriculoperitoneal (VP) shunt placement.
  • Case 3: Radiotherapy-induced tumor shrinkage led to pneumocephalus after partial excision without sellar floor repair.

Findings:

  • Causative factors include intraoperative cerebrospinal fluid (CSF) leaks, post-operative CSF diversion, and tumor volume changes.
  • Conservative management was unsuccessful in two cases.

Related Experiment Videos

  • Sellar floor and sphenoid sinus repair was required in all three presented cases.

    • Implications:

    • Sellar floor repair is recommended after all transsphenoidal approaches, irrespective of intraoperative CSF leak or extent of tumor excision.
    • Early surgical repair of the sellar floor and sphenoid sinus is essential for managing established pneumocephalus, preceding intracranial pressure reduction measures.