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Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 231-237

Symptomatic pneumocephalus following spine surgery: An institutional experience and review of literature

Spine Department, Stavya Spine Hospital and Research Institute, Ahmedabad, Gujarat, India

Correspondence Address:
Dr. Amit Jain
Stavya Spine Hospital and Research Institute, Mithakali, Ahmedabad, Gujarat.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/isj.isj_4_19

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Purpose: The objective of this study was to alert spine surgeons about possibility of pneumocephalus after spine surgery and elaborate its causes, pathophysiology, symptomatology, and management. Materials and Methods: Four patients identified to have symptomatic pneumocephalus after spinal surgery (out of total 7940 operated spine cases over a period of 5 years from January 2013 to December 2017), were included in the study. Compiled data of medical records, operative notes, in-patient treatment records, and radiological findings of these patients were evaluated. Results: All four patients had dural injury with cerebrospinal fluid (CSF) leak. Dura was repaired in two patients and was covered with fat graft in other two. Bifrontal pneumocephalus occurred in three patients while one had intraparenchymal pneumocephalus. All patients were managed conservatively with Trendelenburg position, O2 inhalation, and intravenous hydration along with supportive measures. Conclusion: Pneumocephalus is a rare but serious complication following spine surgery and should be considered in the differential diagnosis in patients presenting in postoperative period with unexplained headache, confusion, and altered sensorium. A high index of suspicion is required to make a diagnosis. Computed tomography scan or magnetic resonance imaging of the brain is required to establish the diagnosis. Most cases respond favorably to conservative treatment. However, occurrence of tension pneumocephalus is a life-threatening condition and might require urgent neurosurgical intervention.

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