Artikel
Pneumocephalus following thoracic surgery with posterior chest wall resection: A case report
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Autoren
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I. Müller
- Thoraxchirurgie, Helios Klinikum Emil v. Behring, Berlin
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E. Alarcon-Drüge
- Thoraxchirurgie, Helios Klinikum Emil v. Behring, Berlin
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M. Tönnies
- Thoraxchirurgie, Helios Klinikum Emil v. Behring, Berlin
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J. Pfannschmidt
- Thoraxchirurgie, Helios Klinikum Emil v. Behring, Berlin
| Veröffentlicht: | 14. Oktober 2013 |
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Gliederung
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Objective: Pneumocephalus has been reported by caused by trauma, neurosurgical procedures, epidural catheter placement and in very rare cases after thoracotomy with chest wall resection.
Methods: We report of a 69-year-old patient with a right sided NSCLC who received two cycles of neoadjuvant chemotherapy and radiotherapy. Subsequently an en bloc resection of the right upper lobe with chest wall resection of the ribs two, three and four combined with the corresponding transverse processes of the spine was performed. On the first postoperative day the patient developed somnolence with no response to pain stimuli and anisocoria. The CCT scan showed an extensive pneumocephalus of both hemispheres. Immediately the epidual catheter was removed as one potential cause of the findings and the patient was transfered to the neurosurgical department.
Results: Although the patient showed complete regression of his neurological symptoms within the next 48 hours, in the following he complained again of neurological symptoms with nausea and vertigo.
Pleural fluid analysis revealed a high level of beta-trace-protein. In order to confirm and locate the cerebrospinal leakage myelography and MRI was done. The imaging showed extravasation of fluid from the right T2 to T3 nerve root. Closure of the spinal leakage was achieved by laminectomy and ligature of the transected nerve roots. After operation the patient returned to his baseline mental status within hours.
Conclusion: Pneumocephalus is a rare but serious complication after thoracic surgery with dorsal chest wall resection. The scarce international literature on pneumocephalus recommends conservative therapy with bed rest, flat-head position and removal of the chest tube from suction. Patients with persistent cerebrospinal fistula require a neurosurgical procedure to occlude the leakage. Within 24 to 48 hours after operation, most of the reported patients showed rapid improvement of their neurological symptoms.
See Figure 1 [Fig. 1], Figure 2 [Fig. 2], Figure 3 [Fig. 3].
