Am. Sawka et al., Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo Clinic experience 1976-1998, J CLIN END, 84(12), 1999, pp. 4731-4734
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.