TY - JOUR
T1 - Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery
T2 - Mayo Clinic experience 1976-1998
AU - Sawka, Anna M.
AU - Aniszewski, Jaroslaw P.
AU - Young, William F.
AU - Nippoldt, Todd B.
AU - Yanez, Paulino
AU - Ebersold, Michael J.
PY - 1999
Y1 - 1999
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0033305675&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033305675&partnerID=8YFLogxK
U2 - 10.1210/jcem.84.12.6197
DO - 10.1210/jcem.84.12.6197
M3 - Article
C2 - 10599742
AN - SCOPUS:0033305675
SN - 0021-972X
VL - 84
SP - 4731
EP - 4734
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 12
ER -