Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo Clinic experience 1976-1998

Anna M. Sawka, Jaroslaw P. Aniszewski, William Francis Young, Todd B. Nippoldt, Paulino Yanez, Michael J. Ebersold

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

We describe four cases of symptomatic pneumocranium, a rare, potentially life-threatening complication of transsphenoidal pituitary surgery. Symptomatic pneumocranium manifested as impaired mental status, headaches, and grand real seizures, early in the postoperative course after transsphenoidal pituitary surgery. Furthermore, a Cushing response, including systemic hypertension and bradycardia (secondary to intracranial hypertension) was seen, which has not been previously described in association with symptomatic pneumocranium. We describe a previously unreported risk factor for tension pneumocranium, untreated obstructive sleep apnea. Other factors predisposing to tension pneumocranium in our patients included: cerebrospinal fluid leaks, post-operative positive-pressure mask ventilation, large pituitary tumors, and intraoperative lumbar drainage catheters. Surgical drainage of the pneumocranium and repair of any coexistent cerebrospinal fluid leak markedly improved neurologic status. Symptomatic pneumocranium occurring early in the postoperative course after transsphenoidal pituitary surgery is rare, but prompt recognition and treatment of this condition can be life-saving.

Original languageEnglish (US)
Pages (from-to)4731-4734
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume84
Issue number12
StatePublished - 1999

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Surgery
Cerebrospinal fluid
Drainage
Intracranial Hypertension
Positive-Pressure Respiration
Catheters
Pituitary Neoplasms
Obstructive Sleep Apnea
Bradycardia
Masks
Causality
Nervous System
Ventilation
Headache
Tumors
Seizures
Repair
Hypertension
Cerebrospinal Fluid Leak
Therapeutics

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery : Mayo Clinic experience 1976-1998. / Sawka, Anna M.; Aniszewski, Jaroslaw P.; Young, William Francis; Nippoldt, Todd B.; Yanez, Paulino; Ebersold, Michael J.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 84, No. 12, 1999, p. 4731-4734.

Research output: Contribution to journalArticle

Sawka, Anna M. ; Aniszewski, Jaroslaw P. ; Young, William Francis ; Nippoldt, Todd B. ; Yanez, Paulino ; Ebersold, Michael J. / Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery : Mayo Clinic experience 1976-1998. In: Journal of Clinical Endocrinology and Metabolism. 1999 ; Vol. 84, No. 12. pp. 4731-4734.
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