Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery : Mayo clinic experience 1976-1998

We describe four cases of symptomatic pneumocranium, a rare, potentially life-threatening complication of transsphenoidal pituitary surgery. Symptomatic pneumocranium manifested as impaired mental status, headaches, and grand mal seizures, early in the postoperative course after transsphenoidal pitu...

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Bibliographic Details
Published in:The journal of clinical endocrinology and metabolism 1999-12, Vol.84 (12), p.4731-4734
Main Authors: SAWKA, A. M, ANISZEWSKI, J. P, YOUNG, W. F, NIPPOLDT, T. B, YANEZ, P, EBERSOLD, M. J
Format: Article
Language:English
Subjects:
Adenoma - surgery
Adult
Aged
Biological and medical sciences
Craniopharyngioma - surgery
Cushing Syndrome - surgery
Female
Humans
Male
Medical sciences
Middle Aged
Neurosurgery
Neurosurgical Procedures - adverse effects
Pituitary Gland - surgery
Pituitary Neoplasms - surgery
Pneumocephalus - diagnosis
Pneumocephalus - etiology
Pneumocephalus - surgery
Postoperative Complications
Skull, brain, vascular surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tomography, X-Ray Computed
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Summary:We describe four cases of symptomatic pneumocranium, a rare, potentially life-threatening complication of transsphenoidal pituitary surgery. Symptomatic pneumocranium manifested as impaired mental status, headaches, and grand mal seizures, early in the postoperative course after transsphenoidal pituitary surgery. Furthermore, a Cushing response, including systemic hypertension and bradycardia (secondary to intracranial hypertension) was seen, which has not been previously described in association with symptomatic pneumocranium. We describe a previously unreported risk factor for tension pneumocranium, untreated obstructive sleep apnea. Other factors predisposing to tension pneumocranium in our patients included: cerebrospinal fluid leaks, postoperative positive-pressure mask ventilation, large pituitary tumors, and intraoperative lumbar drainage catheters. Surgical drainage of the pneumocranium and repair of any coexistent cerebrospinal fluid leak markedly improved neurologic status. Symptomatic pneumocranium occurring early in the postoperative course after transsphenoidal pituitary surgery is rare, but prompt recognition and treatment of this condition can be life-saving.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.84.12.4731