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Nader Pouratian - One of the best experts on this subject based on the ideXlab platform.

  • symptomatic Pneumocephalus after deep brain stimulation surgery report of 2 cases
    Stereotactic and Functional Neurosurgery, 2020
    Co-Authors: Luigi Albano, Pratik Rohatgi, Alon Kashanian, Ausaf A Bari, Nader Pouratian
    Abstract:

    BACKGROUND Symptomatic Pneumocephalus is an uncommon complication of cranial surgery. Reports of symptomatic Pneumocephalus in deep brain stimulation (DBS) surgery are lacking, due to the rarity of this condition. The -authors describe 2 patients who experienced clinically significant intraparenchymal Pneumocephalus as a consequence of DBS surgery and report their clinical presentations, treatments, and outcomes. Cases Descriptions: The first patient was a 69-year-old woman with Parkinson disease and the second was a 73-year-old woman with medically refractory essential tremor. Both patients underwent DBS implantation and developed focal neurological deficits in the days after surgery. In each case, immediate postoperative head computed tomography scans showed extra-axial Pneumocephalus which redistributed on subsequent imaging along the dorsal length of the lead. For each patient, a second surgery was carried out to evacuate the Pneumocephalus without lead removal. Clinical symptoms and radiological signs of intracranial air were resolved on the last follow-up. CONCLUSION Symptomatic intraparenchymal Pneumocephalus is a rare complication of DBS surgery which can be treated with surgical evacuation.

  • effect of cranial window diameter during deep brain stimulation surgery on volume of Pneumocephalus
    Neuromodulation, 2015
    Co-Authors: Justin Sharim, Patrick Pezeshkian, Antonio A F Desalles, Nader Pouratian
    Abstract:

    Objective Successful deep brain stimulation (DBS) surgery necessitates high accuracy in targeting specific intracranial nuclei. Brain shift due to Pneumocephalus can contribute to decreased accuracy. Larger burr holes and dural openings may increase Pneumocephalus volume due to a greater degree of communication between the subdural space and extracranial air. The aim of this study is to determine if there is a statistically and clinically significant difference in postoperative Pneumocephalus volume related to burr hole and durotomy size. Materials and Methods DBS electrodes were surgically implanted through either large (14 mm) burr holes or small (4 mm) twist drill holes. Immediate postoperative computerized tomography (CT) scans of 165 electrode implantations in 85 patients from 2010 to 2013 were retrospectively analyzed. Student's t-test and Mann–Whitney U-test were employed with a threshold of significance set at p ≤ 0.05. Results No significant difference in Pneumocephalus was identified between patients who had implantation of DBS electrodes through 4 mm twist drill holes (N = 71 hemispheres, 12.84 ± 9.79 cm3) and those with large 14 mm burr holes (N = 87, 11.70 ± 7.46 cm3, p = 0.42). Volume of Pneumocephalus did not correlate with duration of surgery or patient age. The groups did not differ significantly with respect to other aspects of surgical implantation technique or surgical duration. Conclusion While identifying factors that may reduce Pneumocephalus volume may be critical to improving stereotactic accuracy and targeting, the current results suggest that burr hole size may not alter the degree of brain shift.

Keith Schaible - One of the best experts on this subject based on the ideXlab platform.

  • From Toothpick to Intraparenychmal Otogenic Pneumocephalus: A Case Report
    World neurosurgery, 2020
    Co-Authors: Megan M. Finneran, Isis Duran, Keith Schaible
    Abstract:

    Background Intracranial Pneumocephalus, the accumulation of air, occurs most frequently from trauma, tumor, cranial surgeries, or infection. Intraparenchymal otogenic Pneumocephalus is a rare but well-documented development. We describe a patient who developed Pneumocephalus in the context of eardrum perforation secondary to toothpick use for ear wax. Case Description An 86-year-old female presented to the emergency room with a 1-day history of dysarthria and a few days of cough and sneezing. History revealed she had recently been advised to avoid Q-Tips to clean her ears and instead was using toothpicks. She denied otalgia or otorrhea and had no signs of infection near the ear. On otoscopic examination, the right tympanic membrane was perforated. On head computed tomography, she was found to have a large right temporal Pneumocephalus extending from the petrous bone. Magnetic resonance imaging of the brain revealed a defect in the right tegmen. She was started on empiric antibiotics and subsequently taken to the operating room for craniotomy and repair of bony and dural defects. Conclusions Otogenic Pneumocephalus is a rare occurrence. This is the first reported case of Pneumocephalus related to self-induced middle ear trauma with a toothpick that ultimately required craniotomy for repair.

  • spontaneous intraventricular tension Pneumocephalus case report and review of the literature
    World Neurosurgery, 2018
    Co-Authors: Michael Young, Matthew Putty, Keith Schaible
    Abstract:

    Background Intracranial Pneumocephalus is a well-known clinical entity most frequently caused by trauma and intracranial surgery. A less frequent cause of intracranial Pneumocephalus is spontaneous Pneumocephalus. Spontaneous Pneumocephalus can have an intraventricular extension, causing tension intraventricular Pneumocephalus. Case Description We present an exceptionally rare case of spontaneous otogenic intraventricular Pneumocephalus in a 58-year-old female that resulted in a decline in mentation and neurologic deficit. The patient was subsequently treated with ventriculostomy and middle fossa craniotomy, with repair of a bony defect and dural closure. Conclusions This case demonstrates an unusual presentation of spontaneous intraventricular tension Pneumocephalus necessitating ventriculostomy in addition to the traditional repair of a cerebrospinal fluid fistula.

Akiyoshi Namiki - One of the best experts on this subject based on the ideXlab platform.

Ali Fatih Ramazanoglu - One of the best experts on this subject based on the ideXlab platform.

Theodore H Schwartz - One of the best experts on this subject based on the ideXlab platform.

  • Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative csf leaks
    Journal of Neurosurgery, 2014
    Co-Authors: Matei A Banu, Oszkar Szentirmai, Lino Mascarenhas, Al Amin Salek, Vijay K Anand, Theodore H Schwartz
    Abstract:

    Object Postoperative Pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative Pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of Pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and Pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify Pneumocephalus patterns based on size and morphology. Pneumoc...