Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis

Abstract

Symptomatic spontaneous pneumocephalus after a spinal fusion for spondylolisthesis without injury to the dura mater is rare. There are only a few reports of tension pneumocephalus after spinal operations published in English. We present a patient who developed tension pneumocephalus without recognised dural injury during surgery. CT cisternography and MRI showed no anatomical defects that could have caused the pneumocephalus. We suggest that spontaneous pneumocephalus without dural injury may occur after a spondylolisthesis operation because of increased intra-abdominal pressure, and thus may be avoided by the careful management of abdominal pressure.

Introduction

Pneumocephalus is the entry of air into the cranium and can be classified as epidural, subdural, subarachnoid, ventricular, and intracerebral.¹ The epidural type is usually seen in patients with a frontal sinus fracture in which the dura mater remains intact, whereas in the subdural type, a dural defect accompanies the cranial fracture. In subarachnoid and ventricular types, the arachnoid is torn in addition to the dural defect.

Pneumocephalus after a spinal operation is rare. We present a patient with tension pneumocephalus after a spinal fusion for spondylolisthesis without any recognised perioperative dural injury.