Tension pneumocephalus resulting from iatrogenic subarachnoid-pleural fistulae: Report of three cases Journal Article

Authors: Bilsky, M. H.; Downey, R. J.; Kaplitt, M. G.; Elowitz, E. H.; Rusch, V. W.
Article Title: Tension pneumocephalus resulting from iatrogenic subarachnoid-pleural fistulae: Report of three cases
Abstract: Background. Symptomatic pneumocephalus may result from a cerebrospinal fluid leak communicating with extradural air. However, it is a rare event after thoracic surgical procedures, and its management and physiology are not widely recognized. Methods. During the past 2 years, we have identified 3 patients who developed pneumocephalus after thoracotomy for tumor resection. Only 1 patient had a discernible spinal fluid leak identified intraoperatively. Two patients experienced delayed spinal fluid drainage from their chest tubes and subsequently developed profound lethargy, confusion, and focal neurologic signs. The third patient was readmitted to the hospital with a delayed pneumothorax and altered mental status. Radiographic imaging in all patients showed significant pneumocephalus of the basilar cisterns and ventricles. Results. The first 2 patients were managed by discontinuation of the chest tube suction and bedrest. The third patient underwent surgical reexploration and nerve root ligation. All 3 patients had resolution of their symptoms within 72 hours. Conclusions. Pneumocephalus is a rare, but serious, complication of thoracotomy. Previous patients reported in the literature have been managed with reoperation to ligate the nerve roots. However, the condition resolved nonoperatively in 2 of our patients. Discontinuation of chest tube suction may be definitive treatment and is always the important initial management to decrease cerebrospinal fluid extravasation into the pleural space and allow normalization of neurologic symptoms. © 2001 by The Society of Thoracic Surgeons.
Keywords: adult; aged; middle aged; cancer surgery; surgical technique; case report; fistula; adenocarcinoma; thoracotomy; lung neoplasms; pneumonectomy; postoperative complications; confusion; brain ventricle; cerebrospinal fluid; intraoperative period; reoperation; mental disease; hospital admission; lethargy; neurologic disease; liquorrhea; pneumocephalus; neurofibroma; pleural neoplasms; subarachnoid space; suction drainage; pleural diseases; chest tubes; humans; human; male; female; priority journal; article; nerve ligation; rhizotomy
Journal Title: Annals of Thoracic Surgery
Volume: 71
Issue: 2
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2001-02-01
Start Page: 455
End Page: 457
Language: English
DOI: 10.1016/s0003-4975(00)02339-0
PUBMED: 11235688
PROVIDER: scopus
Notes: Export Date: 21 May 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Valerie W Rusch
    736 Rusch
  2. Mark H Bilsky
    244 Bilsky
  3. Robert J Downey
    217 Downey