Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema

Li Lian Foo; Sook Hui Chaw; Lucy Chan; Dharmendra Ganesan; Ravindran Karuppiah

doi:10.1016/j.bjane.2015.01.005

Clinical Informations

Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema

Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Li Lian Foo; Sook Hui Chaw; Lucy Chan; Dharmendra Ganesan; Ravindran Karuppiah

http://dx.doi.org/10.1016/j.bjane.2015.01.005 Braz J Anesthesiol, vol.67, n6, p.655-658, 2017

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Abstract

Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Keywords

Intraoperative brain herniation, Tension pneumocephalus, Hydrogen peroxide, Brain amputation

Resumo

Resumo O pneumoencéfalo hipertensivo é raro, mas foi bem documentado após trauma e procedimentos neurocirúrgicos. Trata-se de uma emergência cirúrgica porque pode levar à deterioração neurológica, herniação do tronco cerebral e morte. Ao contrário de casos anteriores, nos quais o pneumoencéfalo hipertensivo se desenvolveu no pós-operatório, descrevemos um caso de pneumoencéfalo hipertensivo desenvolvido no período intraoperatório que levou a uma herniação cerebral súbita, maciça e aberta para fora do local da craniotomia. Os possíveis fatores causais são destacados. É imperativo identificar rapidamente as possíveis causas da herniação cerebral aguda no intraoperatório, incluindo o pneumoencéfalo hipertensivo, e instituir medidas apropriadas para minimizar os danos neurológicos.

Palavras-chave

Herniação cerebral no intraoperatório, Pneumoencéfalo hipertensivo, Peróxido de hidrogênio, Amputação cerebral

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Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema

Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Li Lian Foo; Sook Hui Chaw; Lucy Chan; Dharmendra Ganesan; Ravindran Karuppiah

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