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

Rev Bras Anestesiol. 2017 Nov-Dec;67(6):655-658. doi: 10.1016/j.bjan.2015.09.006. Epub 2016 Sep 28.
[Article in Portuguese]

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: Amputação cerebral; Brain amputation; Herniação cerebral no intraoperatório; Hydrogen peroxide; Intraoperative brain herniation; Peróxido de hidrogênio; Pneumoencéfalo hipertensivo; Tension pneumocephalus.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Brain Diseases / etiology*
  • Drainage*
  • Empyema, Subdural / surgery*
  • Female
  • Hernia / etiology*
  • Humans
  • Intraoperative Complications / etiology*
  • Pneumocephalus / complications*
  • Severity of Illness Index