Chang CY, Hung CC, Liu JM, Chiu CD. Tension pneumocephalus following endoscopic resection of a mediastinal thoracic spinal tumor: A case report. World J Clin Cases 2022; 10(2): 725-732 [PMID: 35097100 DOI: 10.12998/wjcc.v10.i2.725]
Corresponding Author of This Article
Cheng-Di Chiu, MD, PhD, Associate Professor, Deputy Director, Department of Neurosurgery, China Medical University Hospital, No. 2 Yu-Der Road, North Area, Taichung, Taiwan 40447, Taiwan. cdchiu4046@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chao-Yuan Chang, Cheng-Che Hung, Cheng-Di Chiu, Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
Ju-Mien Liu, Department of Pathology, Puli Christian Hospital, Nantou 54041, Taiwan
Author contributions: Chiu CD designed the study; Liu JM and Hung CC acquired the patient’s data; Chang CY analyzed and interpreted the data and drafted the manuscript; Chang CY and Chiu CD revised the manuscript critically for important intellectual content; all authors read and approved the final manuscript.
Supported byChina Medical University Hospital (No. DMR-107-063).
Informed consent statement: The patient has provided informed consent for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Di Chiu, MD, PhD, Associate Professor, Deputy Director, Department of Neurosurgery, China Medical University Hospital, No. 2 Yu-Der Road, North Area, Taichung, Taiwan 40447, Taiwan. cdchiu4046@gmail.com
Received: August 19, 2021 Peer-review started: August 19, 2021 First decision: November 1, 2021 Revised: November 12, 2021 Accepted: December 7, 2021 Article in press: December 7, 2021 Published online: January 14, 2022
Abstract
BACKGROUND
Pneumocephalus is a rare complication presenting in the postoperative period of a thoracoscopic operation. We report a case in which tension pneumocephalus occurred after thoracoscopic resection as well as the subsequent approach of surgical management.
CASE SUMMARY
A 66-year-old man who received thoracoscopic resection to remove an intrathoracic, posterior mediastinal, dumbbell-shaped, pathology-proven neurogenic tumor. The patient then reported experiencing progressively severe headaches, especially when in an upright position. A brain computed tomography scan at a local hospital disclosed extensive pneumocephalus. Revision surgery for resection of the pseudomeningocele and repair of the cerebrospinal fluid leakage was thus arranged for the patient. During the operation, we traced the cerebrospinal fluid leakage and found that it might have derived from incomplete endoscopic clipping around the tumor stump near the dural sac at the T3 level. After that, we wrapped and sealed all the possible origins of the leakage with autologous fat, tissue glue, gelfoam, and duraseal layer by layer. The patient recovered well, and the computed tomography images showed resolution of the pneumocephalus.
CONCLUSION
This report and literature review indicated that the risk of developing a tension pneumocephalus cannot be ignored and should be monitored carefully after thoracoscopic tumor resection.
Core Tip: Pneumocephalus is a rare complication that presents during the postoperative period following a thoracoscopic resection of spinal dumbbell tumors. Here, we present a potential method for resolving tension pneumocephalus and present our detailed experiences following the thoracoscopic resection of a posterior mediastinal dumbbell tumor, together with a review of the literature. The risks of experiencing pneumocephalus following thoracoscopic resection for a spinal tumor cannot be neglected because intraoperative repair is difficult to assess.
