Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: A prospective study

1986 ◽  
Vol 83 (3-4) ◽  
pp. 112-115 ◽  
Author(s):  
N. Di Lorenzo ◽  
R. Caruso ◽  
R. Floris ◽  
V. Guerrisi ◽  
L. Bozzao ◽  
...  
Keyword(s):  
Prospective Study ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Tension Pneumocephalus ◽  
A Prospective Study

scholarly journals Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery

2020 ◽  
Vol 162 (11) ◽  
pp. 2629-2636
Author(s):  
Kathrin Machetanz ◽  
Felix Leuze ◽  
Kristin Mounts ◽  
Leonidas Trakolis ◽  
Isabel Gugel ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Supine Position ◽  
Tumor Size ◽  
Clinical Symptoms ◽  
Neurosurgical Procedures ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Tension Pneumocephalus ◽  
Replacement Procedure ◽  
Duration Of Surgery

Abstract Background The semi-sitting position in neurosurgical procedures is still under debate due to possible complications such as venous air embolism (VAE) or postoperative pneumocephalus (PP). Studies reporting a high frequency of the latter raise the question about the clinical relevance (i.e., the incidence of tension pneumocephalus) and the efficacy of a treatment by an air replacement procedure. Methods This retrospective study enrolled 540 patients harboring vestibular schwannomas who underwent posterior fossa surgery in a supine (n = 111) or semi-sitting (n = 429) position. The extent of the PP was evaluated by voxel-based volumetry (VBV) and related to clinical predictive factors (i.e., age, gender, position, duration of surgery, and tumor size). Results PP with a mean volume of 32 ± 33 ml (range: 0–179.1 ml) was detected in 517/540 (96%) patients. The semi-sitting position was associated with a significantly higher PP volume than the supine position (40.3 ± 33.0 ml [0–179.1] and 0.8 ± 1.4 [0–10.2], p < 0.001). Tension pneumocephalus was observed in only 14/429 (3.3%) of the semi-sitting cases, while no tension pneumocephalus occurred in the supine position. Positive predictors for PP were higher age, male gender, and longer surgery duration, while large (T4) tumor size was established as a negative predictor. Air exchange via a twist-drill was only necessary in 14 cases with an intracranial air volume > 60 ml. Air replacement procedures did not add any complications or prolong the ICU stay. Conclusion Although pneumocephalus is frequently observed following posterior fossa surgery in semi-sitting position, relevant clinical symptoms (i.e., a tension pneumocephalus) occur in only very few cases. These cases are well-treated by an air evacuation procedure. This study indicates that the risk of postoperative pneumocephalus is not a contraindication for semi-sitting positioning.

Tension pneumocephalus following posterior fossa surgery in sitting position

1990 ◽  
Vol 92 (3) ◽  
pp. 245-248 ◽  
Author(s):  
Anantha Kishan ◽  
M.R.C. Naidu ◽  
K. Muralidhar
Keyword(s):  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Tension Pneumocephalus

Air embolism associated with wounds from a pin-type head-holder

1982 ◽  
Vol 57 (5) ◽  
pp. 710-713 ◽  
Author(s):  
Dachling Pang
Keyword(s):  
Posterior Fossa ◽  
Air Embolism ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Entry Site ◽  
Content Type ◽  
Tension Pneumocephalus ◽  
Head Holder ◽  
Scalp Laceration ◽  
Fine Print

✓ A case of intraoperative air embolism during posterior fossa surgery performed with the patient in the sitting position is reported. The entry site was through a comminuted fracture and scalp laceration resulting from faulty application of a pin-type head-holder. The possible role played by a large tension pneumocephalus in the ingress of venous air is also discussed. Simple precautions regarding the use of the pin-type head-holder are suggested to lessen the possibility of air embolism through the puncture wounds.

Subdural tension pneumocephalos

1979 ◽  
Vol 50 (4) ◽  
pp. 525-527 ◽  
Author(s):  
L. Dade Lunsford ◽  
Joseph C. Maroon ◽  
Peter E. Sheptak ◽  
Maurice S. Albin
Keyword(s):  
Posterior Fossa ◽  
Air Bubbles ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Twist Drill ◽  
Potential Complication ◽  
Content Type ◽  
Tension Pneumocephalus ◽  
Prompt Diagnosis ◽  
Fine Print

✓ Two patients developed subdural tension pneumocephalus after undergoing posterior fossa surgery performed in the sitting position. The mechanism for entry of air into the intracranial compartment is analogous to the entry of air into an inverted soda-pop bottle. As the fluid pours out, air bubbles to the top of the container. We have thus referred to this as the “inverted pop-bottle syndrome.” Computerized tomography provided prompt diagnosis and confirmed brain displacement. Twist-drill aspiration of the air resulted in improvement in both patients, although one patient subsequently died from an intracerebellar hemorrhage. Tension pneumocephalus appears to be another potential complication of posterior fossa surgery in the sitting position. This condition is easily diagnosed and treated, and should be considered whenever a patient fails to recover as expected following posterior fossa surgery.

Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position

2018 ◽  
Vol 160 (3) ◽  
pp. 525-538 ◽  
Author(s):  
Alexandra Sachkova ◽  
Timm Schemmerling ◽  
Maria Goldberg ◽  
Volodymyr Solomiichuk ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Tension Pneumocephalus

EXTENSIVE SPINAL CORD INFARCTION AFTER POSTERIOR FOSSA SURGERY IN THE SITTING POSITION: CASE REPORT

Neurosurgery ◽  
2004 ◽  
Vol 54 (6) ◽  
pp. 1512-1516 ◽  
Author(s):  
Xavier Morandi ◽  
Laurent Riffaud ◽  
Seyed F.A. Amlashi ◽  
Gilles Brassier
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Posterior Fossa ◽  
Spinal Cord Infarction ◽  
Posterior Fossa Surgery ◽  
Sitting Position

P06.05 The Sitting Position in the Very Young Pediatric Population: Pearls and Pitfalls of a 10-Years’ Experience

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii25-ii25
Author(s):  
S Linsler ◽  
F Teping ◽  
J Oertel
Keyword(s):  
Posterior Fossa ◽  
Pediatric Population ◽  
Clinical Status ◽  
Skull Fracture ◽  
Special Focus ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Endoscopic Techniques ◽  
Age At Surgery ◽  
Persistent Foramen Ovale

Abstract BACKGROUND To investigate pearls and pitfalls of the sitting positioning in the pediatric population with special focus on related morbidity and surgical practicability. MATERIAL AND METHODS A retrospective analysis of a prospectively maintained internal database was performed. All pediatric patients younger than 18 years at date of surgery, who underwent procedures in sitting position between 01/2010 and 10/2020 were included into this analysis. RESULTS A total of 42 of posterior fossa surgeries were performed in 38 children between 01/2010 and 10/2020. Mean age at surgery was 8.9 years (13 months - 18 years). Mean height and weight were 134.4 (± 30.2) cm and 36.6 (± 21.7) kg respectively. Three children (7.9%) were diagnosed with persistent foramen ovale. Electrophysiologic monitoring was unremarkable during positioning in all cases. Mean time needed for anesthesiologic preparation and positioning was 84.5 (± 20.6) minutes. Perioperative blood transfusion was needed in 5 cases (11.9%). Incidence of VAE was 11.9%. There was no VAE related severe complication. One child (2.4%) showed postoperative skull fracture and epidural bleeding due to skull clamp application. Clinical status immediately after surgery was favorable or stable in 33 of the cases (78.6%). CONCLUSION Attentive performance and an experienced surgical team provided; the sitting position remains a safe variant for posterior fossa surgery in the pediatric population. Precautious skull clamp application and appropriate monitoring is highly recommended. Considering eloquent aspects, the sitting position offers excellent anatomical exposure and is ideal for combination with endoscopic techniques.

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