Understanding the pathophysiology of tension pneumoventricle: A technical case report
Introduction: Pneumocephalus is the presence of air in the intracranial space. When the air is mostly present in the ventricular system, it is also referred to as pneumoventricle. In some instances, air continues to accumulate over time, exerting mass effect over surrounding neurological structures...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751922000251 |
| _version_ | 1819079091118145536 |
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| author | Jorge A. Roa Rui Feng Alexander J. Schupper Trevor Hardigan Kurt Yaeger Travis Ladner Kaitlin Reilly Tomoyoshi Shigematsu |
| author_facet | Jorge A. Roa Rui Feng Alexander J. Schupper Trevor Hardigan Kurt Yaeger Travis Ladner Kaitlin Reilly Tomoyoshi Shigematsu |
| author_sort | Jorge A. Roa |
| collection | DOAJ |
| description | Introduction: Pneumocephalus is the presence of air in the intracranial space. When the air is mostly present in the ventricular system, it is also referred to as pneumoventricle. In some instances, air continues to accumulate over time, exerting mass effect over surrounding neurological structures and increasing intraventricular and intracranial pressures (tension pneumoventricle). If left untreated, this may lead to rapid deterioration of the level of consciousness, coma, herniation and death. Case presentation: We report the case of a patient with subarachnoid hemorrhage who developed tension pneumoventricle secondary to an iatrogenic cutaneous-ventricular fistula after placement of an external ventricular drain. A surgical technique to manage this condition by replacing air with saline in a non-traumatic manner is presented in detail. We also describe all the nuances and potential pitfalls of this technique. Conclusion: Tension pneumoventricle is a rare but concerning complication of intracranial procedures. When clinically indicated, expedited treatment by EVD placement allows intracranial decompression and slow replacement of the ventricular space with water. |
| first_indexed | 2024-12-21T19:23:28Z |
| format | Article |
| id | doaj.art-d22d5312690e43678e4c6b3ef6f595f8 |
| institution | Directory Open Access Journal |
| issn | 2214-7519 |
| language | English |
| last_indexed | 2024-12-21T19:23:28Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Interdisciplinary Neurosurgery |
| spelling | doaj.art-d22d5312690e43678e4c6b3ef6f595f82022-12-21T18:52:54ZengElsevierInterdisciplinary Neurosurgery2214-75192022-06-0128101511Understanding the pathophysiology of tension pneumoventricle: A technical case reportJorge A. Roa0Rui Feng1Alexander J. Schupper2Trevor Hardigan3Kurt Yaeger4Travis Ladner5Kaitlin Reilly6Tomoyoshi Shigematsu7Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Corresponding author at: 1450 Madison Avenue, Box 1136, KCC 1-North, New York, NY 10029, United States.Introduction: Pneumocephalus is the presence of air in the intracranial space. When the air is mostly present in the ventricular system, it is also referred to as pneumoventricle. In some instances, air continues to accumulate over time, exerting mass effect over surrounding neurological structures and increasing intraventricular and intracranial pressures (tension pneumoventricle). If left untreated, this may lead to rapid deterioration of the level of consciousness, coma, herniation and death. Case presentation: We report the case of a patient with subarachnoid hemorrhage who developed tension pneumoventricle secondary to an iatrogenic cutaneous-ventricular fistula after placement of an external ventricular drain. A surgical technique to manage this condition by replacing air with saline in a non-traumatic manner is presented in detail. We also describe all the nuances and potential pitfalls of this technique. Conclusion: Tension pneumoventricle is a rare but concerning complication of intracranial procedures. When clinically indicated, expedited treatment by EVD placement allows intracranial decompression and slow replacement of the ventricular space with water.http://www.sciencedirect.com/science/article/pii/S2214751922000251Tension pneumoventricleCutaneous-ventricular fistulaIntracranial hypertensionExternal ventricular drainComplication |
| spellingShingle | Jorge A. Roa Rui Feng Alexander J. Schupper Trevor Hardigan Kurt Yaeger Travis Ladner Kaitlin Reilly Tomoyoshi Shigematsu Understanding the pathophysiology of tension pneumoventricle: A technical case report Interdisciplinary Neurosurgery Tension pneumoventricle Cutaneous-ventricular fistula Intracranial hypertension External ventricular drain Complication |
| title | Understanding the pathophysiology of tension pneumoventricle: A technical case report |
| title_full | Understanding the pathophysiology of tension pneumoventricle: A technical case report |
| title_fullStr | Understanding the pathophysiology of tension pneumoventricle: A technical case report |
| title_full_unstemmed | Understanding the pathophysiology of tension pneumoventricle: A technical case report |
| title_short | Understanding the pathophysiology of tension pneumoventricle: A technical case report |
| title_sort | understanding the pathophysiology of tension pneumoventricle a technical case report |
| topic | Tension pneumoventricle Cutaneous-ventricular fistula Intracranial hypertension External ventricular drain Complication |
| url | http://www.sciencedirect.com/science/article/pii/S2214751922000251 |
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