抄録
Three cases in which massive pneumocephalus caused a grave postoperative neurological deterioration are presented. Two of the three patients underwent suboccipital craniectomy for posterior fossa tumors. One patient developed tension pneumocephalus immediately after the surgery due to uncontrolled drainage of cerebrospinal fluid (CSF) during surgery and prolonged use of nitrous oxide for anesthesia. The other patient developed massive pneumocephalus the day after the surgery, caused by excess drainage of CSF from an epidural drain and entry of air from the ventriculostomy. The third patient developed tension pneumocephalus following surgery for large bilateral chronic subdural hematomas due to failure of re-expansion of the chronically compressed brain and plugging of the drainage tube. All three patients were successfully treated by aspiration of air under pressure and replacement of air with normal saline.
Tension pneumocephalus should be considered in the differential diagnosis of acute postoperative neurological deterioration, especially in the presence of a CSF drainage device.
