Background: Pneumocephalus is a well-known phenomenon in which a fistula between the thoracic cavity and the subarachnoid space is one of its rare etiologies.
Methods: We report a new case of pneumocephalus after thoracotomy and review eight similar cases in the literature.
Results: In all cases, an operation was carried out for an intrathoracic neoplasm located at the apex with chest wall invasion. In the presence of symptoms, the diagnosis of pneumocephalus and identification of the subarachnoid pleural fistula were differently supplied by radiographic and isotopic exams. In the follow-up, one patient was affected by meningitis and two patients died.
Conclusions: The occurrence of pneumocephalus must be considered when neurologic problems emerge after thoracotomy. It appears that if conservative treatment fails, surgical closure of the fistula via thoracic or neurosurgical approach is indicated.