Symptomatic compressive pneumocephalus following lumbar decompression surgery

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• 作者：R. Gauthé ; ; ^{gautheremi@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; C. Latrobe ; C. Damade ; E. Foulongne ; X. Roussignol ; M. Ould-Slimane
• 关键词：Pneumocephalus ; Lumbar decompression ; Pneumorachis ; Laminectomy ; Spinal surgery ; Dural tear
• 刊名：Orthopaedics & Traumatology: Surgery & Research
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：102
• 期：2
• 页码：251-253
• 全文大小：715 K

文摘

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.