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      Neumoencéfalo recurrente post quirúrgico, a raíz de dos casos Translated title: Post-surgical late pneumoencephalus, based on two cases

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          Abstract

          Resumen El neumoencéfalo es una patología que comúnmente se presenta después de cirugía neuroquirúrgica y ocasionalmente endonasal. Estos se suelen manejar de manera conservadora, sin embargo, se pueden asociar a distintas etiologías las cuales los hacen recurrir. En este reporte presentamos dos casos de neumoencéfalo tardío post quirúrgico asociado a fístulas de LCR de bajo flujo, donde se discute su clínica, etiología y manejo posterior.

          Translated abstract

          Abstract Pneumocephalus is a pathology that commonly occurs after endonasal surgery, these are usually managed conservatively, however they can be associated with different etiologies which make them recur. In this report we present two cases of post-surgical late pneumocephalus associated with low-flow CSF fistulae, where its symptoms, etiology, and subsequent management are discussed.

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          Causes of pneumocephalus and when to be concerned about it.

          Intracranial gas is commonly detected on neuroimaging. The recognition of this finding can at first blush be unsettling. Being able to localize this gas to a specific compartment: intraarterial, intravenous, intraparenchymal, subdural, epidural, subarachnoid and intraventricular, is the first step in determining the importance of the gas. Determination of the route of entry: through the skull, extension from a paranasal sinus or the mastoid air cells, via the spine, or trans-vascular, is the other important factor in determining potential consequences. Understanding these parameters allows for a confident determination of etiology. More importantly, it generally provides guidance as to what must be done: either to disregard (e.g., subarachnoid gas following lumbar puncture and intravenous gas following IV placement), obtain follow-up (e.g., postoperative gas), or administer emergent treatment (e.g., intraarterial gas and epidural abscess). In this review, we use gas location and route of entry to classify the various causes of pneumocephalus and provide examples of each of these etiologies.
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            Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review

            Purpose Tension pneumocephalus (TP) caused by endoscopic endonasal surgery is a serious complication. We report four cases of TP caused by endoscopic surgery and review other cases in the literature, with special attention devoted to symptoms, imaging features, and therapeutic approaches. Methods A retrospective chart review of patients who experienced TP caused by endoscopic surgery in our institution between 2015 and 2018 was performed. Additionally, the MEDLINE database was searched for all case series or reports of TP caused by endoscopic surgery. Results Eighteen articles were identified for review, including four cases from the authors’ institution; ultimately, 26 cases were included in the present study. The main symptoms of TP were headache and a change in mental status. Cerebrospinal fluid (CSF) leakage was reported in 21 of the 26 patients (80.8%). Eight of the 26 patients (30.8%) presented with the “Mount Fuji sign” imaging feature. Twenty-four patients were treated with surgical intervention for TP (endoscopic multilayer closure of skull base defect, cranial burr hole, or bifrontal craniotomy). In addition, the present study is the first to report two patients with TP who were successfully treated conservatively. Conclusion The therapeutic method for treating TP should depend on the degree of the mass effect and clinical symptoms. When patients with TP present with obvious symptoms of CSF leakage and intracranial hypertension, urgent surgical multilayer repair of the skull base defects and/or release of the intracranial pressure are keys to treating these patients. However, conservative treatment under close observation is also feasible when the related symptoms are not overtly obvious.
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              Endoscopic Skull Base Repair Strategy for CSF Leaks Associated with Pneumocephalus

              Background: Cerebrospinal (CSF) fluid leaks with associated pneumocephalus (PNC) represent a condition bearing serious risks for the patient, with little data available in the literature. Reported success rates of endoscopic skull base repair are lower when PNC is associated than in the case of simple CSF leaks. The present study represents an analysis of our experience with endoscopic management of this condition. Methods: Records of patients with pneumocephalus and associated CSF leaks, who underwent endoscopic skull base repair, were reviewed. Demographics, history, etiology of PNC, size of defect, surgical approach, reconstruction technique and complications were evaluated. Results: Twenty patients with CSF leaks and PNC underwent endonasal repair by the senior author between 2005 and 2019. Defect size was larger than 15 mm in all cases. All patients presented either worsening of PNC under conservative treatment or tension PNC. First-attempt closure of the defect was successful in all patients (100%), with resolution of the pneumocephalus. One patient developed a synechia in the proximity of the frontal ostium, as a postoperative complication. The mean follow-up was 39 months (range: 15–94 months). Conclusion: The present study represents a proposed argument for earlier endoscopic endonasal treatment in patients presenting CSF leaks and pneumocephalus.
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                Author and article information

                Journal
                orl
                Revista de otorrinolaringología y cirugía de cabeza y cuello
                Rev. Otorrinolaringol. Cir. Cabeza Cuello
                Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (Santiago, , Chile )
                0718-4816
                2023
                : 83
                : 3
                : 249-253
                Affiliations
                [2] Santiago Santiago de Chile orgnameUniversidad del Desarrollo orgdiv1Facultad de Medicina Clínica Alemana Chile
                [3] Santiago orgnameClínica Alemana de Santiago orgdiv1Servicio de Neurocirugía Chile
                [4] Santiago Santiago de Chile orgnameUniversidad del Desarrollo orgdiv1Escuela de Medicina Chile
                [1] Santiago orgnameClínica Alemana de Santiago orgdiv1Servicio de Otorrinolaringología Chile
                Article
                S0718-48162023000300249 S0718-4816(23)08300300249
                10.4067/s0718-48162023000300249
                6b6d239c-c264-4811-8642-b33c00d68353

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 14 April 2023
                : 13 May 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 8, Pages: 5
                Product

                SciELO Chile

                Categories
                CASOS CLÍNICOS

                cirugía endonasal,fístula LCR,neumoencéfalo,endonasal surgery,CSF fistula,pneumocephalus

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