• World Neurosurg · Sep 2020

    Case Reports

    Tension Pneumocephalus from Positive Pressure Ventilation Following Endoscopic Skull Base Surgery: Case Series and an Institutional Protocol for the Management of Postoperative Respiratory Distress.

    • Mendel Castle-Kirszbaum, Yi Yuen Wang, James King, Brent Uren, Martin Kim, R Andrew Danks, and Tony Goldschlager.
    • Department of Neurosurgery, Monash Health, Melbourne, Australia. Electronic address: mdck.journal@gmail.com.
    • World Neurosurg. 2020 Sep 1; 141: 357-362.

    BackgroundTension pneumocephalus (TP) is a rare but feared complication of endoscopic endonasal skull base surgery. In contrast to simple pneumocephalus, which is common after endoscopic transnasal approaches and managed conservatively, TP represents a neurosurgical emergency and mandates urgent decompression.Case DescriptionHere we present 2 cases of TP as a consequence of positive pressure ventilation following endoscopic endonasal skull base surgery. Both occurred during resuscitation for postoperative hypoxia. These cases prompted the development of an institution-wide protocol to identify and manage patients at risk of TP after extended skull base approaches.ConclusionsTo our knowledge, these are the only such cases of postoperative TP following positive pressure ventilation in the literature.Copyright © 2020 Elsevier Inc. All rights reserved.

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