Tension pneumocranium developes when there is a continuous accumulation of air in the intracranial cavity. It is a rarely encounterable but treatable neurosurgical emergency. A high index of clinical suspicion with corroboration of imaging is needed for accurate diagnosis and prompt action is required to avoid severe consequences. Most patients were treated with decompressive surgery from previous literatures and seldom treated conservatively. A case of tension pneumocranium in a 73 years old women patient who had undergone bifrontal craniotomy and transnasal endoscopic resection of cribriform plate meningioma was described. It was aggravated by lumbar drainage. She was subsequent successfully treated conservatively without any decompressive surgery. This case report discusses the pathophysiology, clinical presentation and the pertinent imaging features of …show more content…
It usually resolves without any sequelae. However as the amount of air continuously increases in the vault, it becomes tension pneumocephalus that can cause serious complications if untreated. As a result it is important to identified and differentiate a tension pneumocranium from a simple pneumocranium with its characteristics. Computed tomography scanning is the choice of diagnostic modality for the diagnosis of tension pneumocranium with its specific features in the scan. We present a case of 73 years old women who developed tension pneumocranium after a bifrontal craniotomy and transnasal endoscopic resection of a cribriform meningioma which was aggrevated by lumbar drainage. The lumbar drain was inserted as a method of reducing cerebral spinal fluid leakage. She was successfully managed conservatively without decompressive surgery. In the report the underlying pathophysiology, clinical presentation, diagnosis, and management of tension pneumocephalus will be
An MRI was performed of the lumbar spine. The examination found no significant extra
Without this treatment, I fear her condition will continue to progress causing increased pain and suffering with a potentially fatal
One of the leading guesses is that Transverse Sinus Stenosis is the cause of Pseudotumor Cerebri. Transverse sinus stenosis is the narrowing of a vein in the brain. A Transverse Sinus Stent is a stent holding open/widening this narrow vein. It was found that most pseudotumor cerebri patients had Transverse Sinus Stenosis as the cause of these conditions. In a clinical trial this
Spinal stenosis results from the narrowing of the spinal canal. All the more particularly, the nerve paths in the vertebrae narrows, in this manner blocking and compressing nerve roots. The condition may stem from abnormalities in the aging spine, or body mechanics. Symptoms may incorporate pain in the neck, shoulder, and arm, or lower back, pain activated by strolling or remaining for expanded periods that are lightened subsequent to sitting down, or flexing forward, muscle spasms or general shortcoming, numbness and tingling or temperature changes in the legs. To Diagnose Spinal Stenosis:
This paper describes a pneumothorax and gives a look into how a pneumothorax
Several detailed laboratory investigations are performed to exclude systemic causes, malignancy, or any other ongoing process that must be excluded prior to repair. In our study most of the septal perforations were caused following septal surgery as mentioned above. Tomography of the paranasal sinuses is indicated to evaluate the nasal septum and the presence of concomitant paranasal sinus disease9. We assessed the size of perforations and the size of the flap available preoperatively using Plain CT-scan of Nose and Paranasal sinuses with a combination of axial and coronal sections. This gave us a clear picture of the defect in the nasal septum along with accurate information of the availability of nasoseptal flap.
The problems that Mr. A is at risk for would include ventilator- associated Pneumonia, coagulation issues, speech compromise and muscle impairments. Although Mr. A. is young, he could still be at risk for pressure ulcers because of lack of movement, decrease nutrition and immunity compromise related to the splenectomy. The nurse will have to monitor vital signs, laboratory values, intake and output, wound healing and the patient as a
A total of 52 patients were enrolled, 25 in Group 1 and 27 in Group 2 (Table 1). The mean postoperative follow-up period was 18 months in Group 1 (range, 12–24 mo) and 18.2 months in Group 2 (range, 14–24 mo). In Group 1 (OD), there were 10 men and 15 women, with a mean age of 58 + 12.4 years. The vertebral level affected was L4–L5 in 14 patients (57.9%), L5–S1 in eight patients (42.1%) and double level in 3 patients. All patients in Group 1 presented with preoperative neurologenic claudication; 0% had motor deficits, 72% had sensory deficits (18 out of 25), and 40% had impaired or absent reflexes (10 out of 25).
The literature states the most common complication to be pneumothorax. In our study the incidence of pneumothorax is16% (11 cases) none of which required placement of chest drainage tubes. The incidence of pneumothorax in studies performed by Lee and Sagel13 is 23-43%, Dennie et al 14 is 22.9%, Simpson RW et al15 is 32%, Poe RH et al16 is 27%, Allison DJ6 is 24%, Swischuk JL et al10 is 26.9%, Miller JA et al12 is 7% and Counes DJ 17 is 18%. The incidence of hemoptysis is 3% in our study which also correlates with Lee and Sagel13 and Simpson RW et al 15 studies where the incidence was < 5%.
The cribriform plate injury with cerebrospinal fluid leak may occur if the dissection is taken too high. Maintenance of proper orientation during dissection is important, and occasional reorientation by placing the scope within the nasal cavity may be helpful. . In a report of 116 patients undergoing endoscopic septoplasty, 4.3% of patients reported transient dental pain or hypesthesia, while less than 1% of patients suffered from epistaxis or septal hematoma following surgery. SUMMARY A useful technique well suited to ESS is Endoscopic septoplasty.
Management and outcome The surgery was successful. The anaesthetist told me he will be like to do awake extubation because patient was grade 2 view on intubation. This method is used to perform an extubation once the patient is fully awake and able to maintain his own airway (e SAFE, 2017) I prepared for awake extubation, all the airway equipment for the intubation were kept for anaesthetic emergence, guedel, laryngoscope, bougie, 20ml syringe.
Passive Hip Stabilization As I mentioned in the last case study, I look at the position of the lower extremities when correcting full body alignment . The legs and feet should be directly underneath the pelvis. The knees and the feet should be pointing up towards the ceiling. Most of the time, I see one of these abnormal postures instead.
In the case of meningiomas, the tumor origin can be found anywhere along the surface of the dura. A general rule is that the neuraxis is displaced to the side opposite to the tumor origin. Therefore, posterior meningiomas put pressure on the spinal cord anteriorly and for this reason are better approached directly with a laminectomy. Posterolateral and lateral meningiomas displace the neuraxis anteromedially and medially, respectively.
Kole’s procedure involves the reflection of full thickness flaps to expose buccal and lingual alveolar bone, followed by interdental cuts through the cortical bone and barely penetrating the medullary bone (corti¬cotomy style). The subapical horizontal cuts connecting the interdental cuts were osteotomy style, penetrating the full thickness of the alveolus. Because of the inva¬sive nature of Kole’s technique, it was never widely ac¬cepted. From Koles work arose the term “Bony block” to describe the suspected movement after corticotomy surgery. Koles interpretation of bony block concept prevailed until 2001 publication of Wilcko et al [2].
Mental foramen is one of the most important and studied foramen’s of the mandible. The mandibular foramen is an opening seen on the medial ( internal ) aspect of the mandible which leads into a funnel like mandibular canal,that opens at the mental foramen on the anterolateral surface of the mandible. The mandibular nerve passes through this canal, travels obliquely forward and takes a turn from the incisal region to reach the mental foramen and exit as inferior alveolar nerve and vessels. It is this inferior alveolar nerve that branches into the mental nerve which would provide sensory innervation the skin of the chin, the gingiva and mucosa in the region of anterior teeth, lower lip. It is of paramount importance that the surgeons know of