Air embolism from wounds from a pin-type head-holder as a complication of posterior fossa surgery in the sitting position

1981 ◽  
Vol 55 (1) ◽  
pp. 147-148 ◽  
Author(s):  
José M. Cabezudo ◽  
Fernando Gilsanz ◽  
Jesús Vaquero ◽  
Eduardo Areitio ◽  
Roberto Martinez
Keyword(s):  
Posterior Fossa ◽  
Supine Position ◽  
Unusual Case ◽  
Air Embolism ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Fixation Device ◽  
Content Type ◽  
Head Holder ◽  
Fine Print

✓ The authors report an unusual case of intraoperative air embolism during posterior fossa surgery in the sitting position. The source of air was one of the wounds made by the pin-type skull fixation device. We suggest that the patients should not be released from such device until they are in the supine position.

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.

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.

Use of ligamentum nuchae graft for dural closure in posterior fossa surgery

1998 ◽  
Vol 89 (1) ◽  
pp. 155-156 ◽  
Author(s):  
Edward J. Kosnik
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leakage ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Fluid Leakage ◽  
Dural Closure ◽  
Fine Print

✓ The technique of harvesting the ligamentum nuchae and its use in posterior fossa surgery are discussed. By using this technique the author has avoided postoperative cerebrospinal fluid leakage in more than 200 procedures.

Unusual CT-dense posterior fossa epidermoid cyst

1981 ◽  
Vol 55 (4) ◽  
pp. 654-656 ◽  
Author(s):  
Robert C. Dunn ◽  
Carol A. Archer ◽  
Richard L. Rapport ◽  
L. M. Looi
Keyword(s):  
Posterior Fossa ◽  
Epidermoid Cyst ◽  
Unusual Case ◽  
Content Type ◽  
Radiological Features ◽  
Fine Print

✓ A posterior fossa epidermoid cyst with high computerized tomographic attenuation is reported. The pathological and radiological features of this unusual case are presented.

Acute pulmonary edema following venous air embolism during a neurosurgical procedure

1974 ◽  
Vol 40 (3) ◽  
pp. 400-404 ◽  
Author(s):  
William F. Chandler ◽  
Donald G. Dimcheff ◽  
James A. Taren
Keyword(s):  
Pulmonary Edema ◽  
Air Embolism ◽  
Acute Pulmonary Edema ◽  
Sitting Position ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Venous Air Embolism ◽  
Cause And Effect ◽  
Possible Cause ◽  
Fine Print

✓ A case of venous air embolism during a procedure in the sitting position is reported in which the patient developed fulminant pulmonary edema within 2 hours of the embolus. Possible cause and effect relationships are discussed.

Quadriplegia in a patient who underwent posterior fossa surgery in the prone position

2002 ◽  
Vol 96 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Cheng-Shyuan Rau ◽  
Cheng-Loong Liang ◽  
Chun-Chung Lui ◽  
Tao-Chen Lee ◽  
Kang Lu
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Cervical Spinal Cord ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Resonance Imaging ◽  
Content Type ◽  
Cervical Disease ◽  
Cerebellar Medulloblastoma ◽  
Weighted Sequences

✓ Quadriplegia is a well-known complication of posterior fossa surgery performed while the patient is in the sitting position but is rarely associated with the prone position. A case of an 18-year-old man with a cerebellar medulloblastoma is described. There was no evidence of previous cervical disease. The patient suffered quadriplegia after undergoing surgery in the prone position. Postoperative magnetic resonance imaging demonstrated a long hyperintense C2—T1 lesion on T2-weighted sequences. The authors speculate that, during the prolonged period in which the neck was in hyperflexion, overstretching of the cervical spinal cord and compromise of its blood supply might have caused this devastating complication.

Intracranial pressure monitoring in the posterior fossa: a preliminary report

1989 ◽  
Vol 71 (4) ◽  
pp. 503-505 ◽  
Author(s):  
Robert H. Rosenwasser ◽  
Laurence I. Kleiner ◽  
Joseph P. Krzeminski ◽  
William A. Buchheit
Keyword(s):  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Early Postoperative Period ◽  
Intracranial Pressure Monitoring ◽  
Posterior Fossa Surgery ◽  
Pressure Monitoring ◽  
Content Type ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ Direct therapeutic drainage and intracranial pressure monitoring from the posterior fossa has never been accepted in neurosurgical practice. Potential complications including cerebrospinal fluid leak, cranial nerve palsies, and brain-stem irritation have been a major deterrent. The authors placed a catheter for pressure monitoring in the posterior fossa of 20 patients in the course of posterior fossa surgery: 14 patients with acoustic schwannomas, four with posterior fossa meningiomas, one with cerebellar hemangioblastoma, and one with a solitary cerebellar metastatic lesion. A Richmond bolt was also placed in the frontal area. Continuous monitoring of the supratentorial and infratentorial compartments was performed for 48 hours. During the first 12 hours the posterior fossa pressure was 50% greater than that of the supratentorial space in all patients (p < 0.01). Over the next 12 hours the supratentorial pressure was 10% to 15% higher than the posterior fossa pressures in all patients, and by 48 hours of monitoring the pressures had equilibrated. There was no mortality or morbidity referable to insertion of the posterior fossa catheter. The conclusions drawn from this study are that: 1) direct monitoring and drainage of the posterior fossa is safe and effective; and 2) within the early postoperative period, the supratentorial pressures failed to reflect what is taking place within the posterior fossa. The implications and advantages of direct posterior fossa monitoring in the postoperative patient are discussed.

Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy

2001 ◽  
Vol 95 (5) ◽  
pp. 791-797 ◽  
Author(s):  
Christian Sainte-Rose ◽  
Giuseppe Cinalli ◽  
Franck E. Roux ◽  
Wirginia Maixner ◽  
Paul D. Chumas ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Endoscopic Third Ventriculostomy ◽  
Tumor Resection ◽  
Third Ventriculostomy ◽  
Posterior Fossa Surgery ◽  
Posterior Fossa Tumors ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors undertook a study to evaluate the effectiveness of endoscopic third ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hôpital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic third ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary third ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between patients in Group A or B with respect to the following variables: age at presentation, evidence of metastatic disease, extent of tumor resection, or follow-up duration. In patients in Group A, however, more severe hydrocephalus was demonstrated (p < 0.01); the patients in Group C were in this respect different from those in the other two groups. Ultimately, there were only four patients (6%) in Group A compared with 22 patients (26.8%) in Group B (p = 0.001) in whom progressive hydrocephalus required treatment following removal of the posterior fossa tumor. Sixteen patients (20%) in Group B underwent insertion of a ventriculoperitoneal shunt, which is similar to the incidence reported in the literature and significantly different from that demonstrated in Group A (p < 0.016). The other six patients (7.3%) were treated by endoscopic third ventriculostomy after tumor resection. In Group C, two patients (4.3%) with postoperative hydrocephalus underwent endoscopic third ventriculostomy. In three patients who required placement of CSF shunts several episodes of shunt malfunction occurred that were ultimately managed by endoscopic third ventriculostomy and definitive removal of the shunt. There were no deaths; however, there were four cases of transient morbidity associated with third ventriculostomy. Conclusions. Third ventriculostomy is feasible even in the presence of posterior fossa tumors (including brainstem tumors). When performed prior to posterior fossa surgery, it significantly reduces the incidence of postoperative hydrocephalus. The procedure provides a valid alternative to placement of a permanent shunt in cases in which hydrocephalus develops following posterior fossa surgery, and it may negate the need for the shunt in cases in which the shunt malfunctions. Furthermore, in patients in whom CSF has caused spread of the tumor at presentation, third ventriculostomy allows chemotherapy to be undertaken prior to tumor excision by controlling hydrocephalus. Although the authors acknowledge that the routine application of third ventriculostomy in selected patients results in a proportion of patients undergoing an “unnecessary” procedure, they believe that because patients' postoperative courses are less complicated and because the incidence of morbidity is low and the success rate is high in those patients with severe hydrocephalus that further investigation of this protocol is warranted.

Early postoperative seizures after posterior fossa surgery

1990 ◽  
Vol 73 (4) ◽  
pp. 541-544 ◽  
Author(s):  
Shih-Tseng Lee ◽  
Tai-Ngar Lui ◽  
Chen-Nen Chang ◽  
Wen-Chun Cheng
Keyword(s):  
Metabolic Acidosis ◽  
Bacterial Meningitis ◽  
Posterior Fossa ◽  
Early Postoperative Period ◽  
Posterior Fossa Surgery ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
The Difference ◽  
Fine Print

✓ A review is reported of the seizure incidence in 726 patients who underwent 740 posterior fossa operations via a suboccipital craniectomy without prophylactic anticonvulsant agents. Thirteen patients (1.8%) experienced seizures within 2 weeks postoperatively. Five of these patients (0.7% of the series) had seizures within 24 hours after operation. The incidence was highest for patients with medulloblastoma (7.2%) followed by those with astrocytoma (2.3%). Also, a higher percentage was found in patients with preoperative ventriculoperitoneal shunt or intraoperative ventriculostomy (2.7%) than in those without (1%), but the difference was not statistically significant. Metabolic acidosis (80%) and hyponatremia (20%) were the major causes of the seizures that developed within 24 hours after operation. Follow-up computerized tomography showed no definite lesion in these patients. Hydrocephalus (75%) and supratentorial hemorrhage remote from the operative site (25%) were detected in the patients who developed seizures between the 2nd and 14th postoperative day. Two of these patients also had postoperative bacterial meningitis. This review suggests that seizures are a possible complication in the early postoperative period after suboccipital craniectomy for posterior fossa lesions.

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