• Yu Zhao, Liming Cao, Qi Sheng, Ruifang Liu, Gaolei Dong, and Xibao Tong.
• Department of Neurology, Shenzhen Third People's Hospital.
• Medicine (Baltimore). 2021 Jun 11; 100 (23): e26322e26322.

RationaleSevere tension pneumocephalus can lead to drowsiness, coma, and even brain hernia and death. The occurrence of delayed pneumocephalus after spinal surgery is rarely reported and often ignored. Herein, we report a case of delayed pneumocephalus after repeated percutaneous aspiration following spinal surgery.Patient ConcernsA 55-year-old man was admitted in October 2020 because of aggravation in bilateral lower limb weakness and dysuria for seven days. He was diagnosed with liver cancer a year ago, and he underwent several operations because of tumor recurrence. The patient underwent thoracic vertebrae tumor excision on this admission, and no cerebrospinal fluid leakage was discovered during surgery. After the third drainage by percutaneous aspiration, the patient complained of severe headache and vomiting on postoperative day 16.DiagnosisEmergency brain computed tomography revealed massive pneumocephalus.InterventionsThereafter, suction drainage was discontinued, and he was placed on bed rest and administered intravenous mannitol.OutcomesRepeated computed tomography showed complete resolution of the pneumocephalus after five days.LessonsWound exudates and cystic fluid after spinal surgery should be differentiated from cerebrospinal fluid leakage. Reckless percutaneous aspirations can form pneumocephalus in patients with an occult dural injury, and pneumocephalus can occur up to 16 days after surgery. Early diagnosis of pneumocephalus is crucial to avoid severe consequences.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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