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

We describe four cases of symptomatic pneumocranium, a rare, potentially li fe-threatening complication of transsphenoidal pituitary surgery. Symptomat ic pneumocranium manifested as impaired mental status, headaches, and grand mal seizures, early in the postoperative course after transsphenoidal pitu itary surgery. Furthermore, a Gushing response, including systemic hyperten sion and bradycardia (secondary to intracranial hypertension) was seen, whi ch has not been previously described in association with symptomatic pneumo cranium. We describe a previously unreported risk factor for tension pneumo cranium, untreated obstructive sleep apnea. Other factors predisposing to t ension pneumocranium in our patients included: cerebrospinal fluid leaks, p ostoperative positive-pressure mask ventilation, large pituitary tumors, an d intraoperative lumbar drainage catheters. Surgical drainage of the pneumo cranium and repair of any coexistent cerebrospinal fluid leak markedly impr oved neurologic status. Symptomatic pneumocranium occurring early in the postoperative course after transsphenoidal pituitary surgery is rare, but prompt recognition and trea tment of this condition can be life-saving.