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Review of the management of pneumocephalus.

Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF - Surg Neurol Int (2015)

Bottom Line: Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures.The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Campo Limpo Municipal Hospital, São Paulo, Brasil.

ABSTRACT

Background: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the "Mount Fuji sign." In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition.

Case description: A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.

Conclusion: The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

No MeSH data available.


Related in: MedlinePlus

(a) Unenhanced axial computed tomography image of the brain demonstrates bilateral subdural areas of hypoattenuation with compression of both frontal lobes. (b) Postoperative computed tomography bone window image demonstrating the small supraorbital craniotomy
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Figure 2: (a) Unenhanced axial computed tomography image of the brain demonstrates bilateral subdural areas of hypoattenuation with compression of both frontal lobes. (b) Postoperative computed tomography bone window image demonstrating the small supraorbital craniotomy

Mentions: A 74-year-old right-handed male was diagnosed with meningioma of olfactory groove several years ago. He presented with psychomotor agitation, confusion, and vertiginous crises. Among its antecedents, surgery for maxillary sinusitis, heart, and mesenteric thrombosis were mentioned. It more recently referred to a mild head injury. On neurological examination, motor or sensory deficits were not evidenced. The cranial nerve examination was normal. The patient underwent magnetic resonance imaging (MRI) that showed olfactory groove meningioma and significant perilesional edema around the tumor. He was initially treated with dexamethasone at a dosage of 4 mg every 6 h. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. The rigid endoscope was used to complete the resection. A computed tomography (CT) scan of the skull performed 24 h later showed bi-frontal subdural PNC with Mount Fuji sign with a slight shift to the right ventricular system and no frontal sinus breaches was identified [Figure 2]. At that time, the patient developed progressive decreased consciousness with a Glasgow coma score (GCS) between 12 and 13 points. He did not complain of a headache and did not have meningeal signs, such as vomiting or fever. Clinical examination revealed no neurological motor deficit. Additionally, no cerebrospinal fluid (CSF) leak or wound infection occurred.


Review of the management of pneumocephalus.

Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF - Surg Neurol Int (2015)

(a) Unenhanced axial computed tomography image of the brain demonstrates bilateral subdural areas of hypoattenuation with compression of both frontal lobes. (b) Postoperative computed tomography bone window image demonstrating the small supraorbital craniotomy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596054&req=5

Figure 2: (a) Unenhanced axial computed tomography image of the brain demonstrates bilateral subdural areas of hypoattenuation with compression of both frontal lobes. (b) Postoperative computed tomography bone window image demonstrating the small supraorbital craniotomy
Mentions: A 74-year-old right-handed male was diagnosed with meningioma of olfactory groove several years ago. He presented with psychomotor agitation, confusion, and vertiginous crises. Among its antecedents, surgery for maxillary sinusitis, heart, and mesenteric thrombosis were mentioned. It more recently referred to a mild head injury. On neurological examination, motor or sensory deficits were not evidenced. The cranial nerve examination was normal. The patient underwent magnetic resonance imaging (MRI) that showed olfactory groove meningioma and significant perilesional edema around the tumor. He was initially treated with dexamethasone at a dosage of 4 mg every 6 h. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. The rigid endoscope was used to complete the resection. A computed tomography (CT) scan of the skull performed 24 h later showed bi-frontal subdural PNC with Mount Fuji sign with a slight shift to the right ventricular system and no frontal sinus breaches was identified [Figure 2]. At that time, the patient developed progressive decreased consciousness with a Glasgow coma score (GCS) between 12 and 13 points. He did not complain of a headache and did not have meningeal signs, such as vomiting or fever. Clinical examination revealed no neurological motor deficit. Additionally, no cerebrospinal fluid (CSF) leak or wound infection occurred.

Bottom Line: Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures.The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Campo Limpo Municipal Hospital, São Paulo, Brasil.

ABSTRACT

Background: Pneumocephalus (PNC) is the presence of air in the intracranial cavity. The most frequent cause is trauma, but there are many other etiological factors, such as surgical procedures. PNC with compression of frontal lobes and the widening of the interhemispheric space between the tips of the frontal lobes is a characteristic radiological finding of the "Mount Fuji sign." In addition to presenting our own case, we reviewed the most relevant clinical features, diagnostic methods, and conservative management for this condition.

Case description: A 74-year-old male was diagnosed with meningioma of olfactory groove several years ago. After no improvement, surgery of the left frontal craniotomy keyhole type was conducted. A computed tomography (CT) scan of the skull performed 24 h later showed a neuroimaging that it is described as the silhouette of Mount Fuji. The treatment was conservative and used continuous oxygen for 5 days. Control CT scan demonstrated reduction of the intracranial air with normal brain parenchyma.

Conclusion: The review of the literature, we did not find any cases of tension pneumocephalus documented previously through a supraorbital keyhole approach. There are a few cases reported of patients with Mount Fuji signs that do not require surgical procedures. The conservative treatment in our report leads to clinical and radiological improvement as well as a reduction in hospitalization time.

No MeSH data available.


Related in: MedlinePlus