Relief of tension pneumocephalus with endotracheal intubation

Surgical Neurology
Antonios MammisMichael Schulder

Abstract

Pneumocephalus is commonly seen after neurosurgical procedures and is usually of little consequence. When an anatomical 1-way valve develops, there can be significant air entrapment, known as tension pneumocephalus. In cases of craniofacial resection, an iatrogenic ball-valve mechanism involving the nasopharynx can be created. In this case of craniofacial resection, we find that a tension pneumocephalus developed after surgery, resulting in a change in the patient's mental status. A latissimus dorsi muscle flap, which had been created during surgery, was found to pulsate with the patient's respirations. This flap, along with the patient's nasopharynx, created a ball valve mechanism which led to entrapment and accumulation of intracranial air. This case demonstrates the use of endotracheal intubation as a means of bypassing a 1-way valve of this nature. Endotracheal intubation in conjunction with twist drill hole aspiration effectively resolves the pneumocephalus by both providing an outlet for trapped air and by removing the ball-valve mechanism from the circuit. Endotracheal intubation should be considered along with twist drill hole aspiration in the emergent management of tension pneumocephalus secondary to a nasopharyngeal ...Continue Reading

References

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Citations

Mar 15, 2013·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Marc C SwanSteven A Wall
Jan 26, 2010·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Benjamin Nicholson, Harinder Dhindsa

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