Symptomatic compressive pneumocephalus following lumbar decompression surgery

Orthopaedics & Traumatology, Surgery & Research : OTSR
R GauthéM Ould-Slimane

Abstract

We report a case of symptomatic postoperative pneumocephalus after lumbar decompression. A 69-year-old man was operated on for a severe lumbar stenosis with a L2-L4 arthrodesis and a spinal decompression. No cerebrospinal fluid leakage was visible but one of the two aspirative drains was accidentally disconnected in recovery room. After 1 day, computed tomography was performed to explore intense lumbar pain and revealed a voluminous pneumorachis. Then, the patient experienced a generalized tonic-clonic seizure. Imaging revealed a voluminous pneumocephalus responsible for a significant space-occupying effect on the frontal lobe. A conservative treatment was initiated, including bed rest, oxygen therapy, neurological monitoring and anti-epileptic therapy. Symptoms gradually improved and he was discharged without any deficit after 10 days. A total radiological regression was noted in 21 days. Prevention of postoperative pneumocephalus should include a systematic repair of iatrogenic dural tear. Even in presence of severe symptomatic manifestations, a conservative treatment is possible.

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Citations

May 24, 2018·The Journal of Spinal Cord Medicine·Ghassen GaderHafedh Jemel
Sep 17, 2017·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Wolfgang Börm
Sep 4, 2021·International Journal of Surgery Case Reports·Osama J Abu-HamdiyahMohammad J Athamneh

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