gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Cerebellar hemorrhage and tension pneumocephalus following resection of a pancoast tumor

Kleinhirnblutung und Spannungspneumenzephalus nach Resektion eines Pancoast-Tumors

Meeting Abstract

  • corresponding author Murat Ladehoff - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck
  • D. Zachow - Abteilung für Radiologie, Universitätsklinikum Schleswig-Holstein, Lübeck
  • G. Nowak - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck
  • A. Echelmeyer - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck
  • H. Arnold - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck
  • A. Giese - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocP 13.144

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2004/04dgnc0428.shtml

Veröffentlicht: 23. April 2004

© 2004 Ladehoff et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Cerebellar hemorrhage after spinal surgery involving the posterior chest wall and development of subarachnoid-pleural fistulas are well described, but uncommon, complications. We present an unusual case of cerebellar hemorrhage followed by tension pneumocephalus and subsequent bacterial meningitis several days after thoracotomy for resection of a pancoast tumor

Clinical presentation

The post-operative course of the 32-year-old patient was complicated by an impaired level of consciousness and agitation. CCT showed a cerebellar hemorrhage and hydrocephalus caused by compression of the fourth ventricle. Immediate surgical evacuation of the hemorrhage and placement of an external ventricular drain was performed. Respirator therapy maintaining a continuous positive airway pressure was required. During this period the ventricular drain was permanently closed. Following weaning and extubation the patient rapidly deteriorated and became comatose. CCT now demonstrated the ventricular system as well as the subarachnoid space dilated and filled with gas. Gas was also in the cervical spinal subarachnoid space. Relief of intracranial pressure was achieved by aspiration of intracranial air through the ventricular drainage. Recurrent deterioration of consciousness after repeated air aspiration indicated rapid refilling of the ventricles with gas.

Intervention

The patient underwent emergency surgical reexploration of the thoracic resection cavity: Dural lacerations of the nerve roots C8 and Th1 were identified and sealed up.

Conclusions

Cerebellar hemorrhage and tension pneumocephalus must be considered in patients with unexplained neurological deterioration after posterior chest wall resection. This initial presentation of a subarachnoid-pleural fistula with a cerebellar haemorrhage followed by a tension pneumocephalus after discontinuation of a continuous positive airway pressure is unusual. To our knowledge this is the first description of these two uncommon complications in one patient after thoracic spine surgery.