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Pneumozephalus als seltene Komplikation einer Narkose

Pneumocephalus as a rare complication of general anesthesia

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Zusammenfassung

Der vorliegende Beitrag berichtet über den Fall eines massiven Pneumozephalus bei einem Patienten, der sich mehr als 10 Jahre nach einem schweren Schädel-Hirn-Trauma einer urologischen Operation in Allgemeinnarkose unterzog. Nach seinerzeit langwierigem Verlauf mit Tracheotomie, dekompressiver Kraniektomie, Rehabilitation, Dekanülierung und Kranioplastie hatte sich der Patient erholt, jedoch blieben eine Hemiparese und eine psychomotorische Antriebsminderung bestehen. Unmittelbar nach einer urologischen Operation verschlechterte sich der neurologische Zustand des Patienten. Eine Schädel-Computertomographie zeigte einen massiven Pneumozephalus bei bestehender Frontobasisverletzung. Nach Rekonstruktion der Frontobasis, Entfernung des alten lumboperitonealen und Neuanlage eines ventrikuloperitonealen Shunt war keine intrakranielle Luft mehr nachweisbar. Zusammenfassend ist festzuhalten, dass eine Schädelbasisverletzung auch noch Jahre nach dem Ereignis, insbesondere im Rahmen der Maskenbeatmung bei einem operativen Eingriff, symptomatisch werden kann.

Abstract

This article reports a case of massive postoperative pneumocephalus in a patient following general anesthesia for a urological procedure. The patient had sustained a severe head injury more than 10 years ago with long-term treatment in an intensive care unit (ICU) including decompressive craniectomy, tracheostomy followed by rehabilitation, decanulation and cranioplasty. The patient recovered but suffered severe hemiparesis and mild neurocognitive deficits. Immediately after the current operation the patient was disoriented and did not recover in an appropriate interval. A cranial computed tomography (CT) scan revealed massive intracranial air and frontobasal skull defects. After frontobasal reconstruction, removal of an old lumboperitonal shunt and placement of a ventriculoperitoneal shunt, intracranial air was no longer observed. In summary a frontobasal injury may become symptomatic many years after injury, especially when face mask ventilation with positive pressure is applied during surgical interventions.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Welschehold, P. Wegermann und A. Reuland geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Sektion Neurotraumatologie und Neurochirurgie, Unfallklinik, Asklepios Klinik Weißenfels, Naumburger Str. 74–76, 06667, Weißenfels, Deutschland

    S. Welschehold M.A. & A. Reuland

  2. Klinik für Anästhesie und Intensivmedizin, Asklepios Klinik Weißenfels, Weißenfels, Deutschland

    P. Wegermann

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  1. S. Welschehold M.A.
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  2. P. Wegermann
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  3. A. Reuland
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Correspondence to S. Welschehold M.A..

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Welschehold, S., Wegermann, P. & Reuland, A. Pneumozephalus als seltene Komplikation einer Narkose. Anaesthesist 63, 309–312 (2014). https://doi.org/10.1007/s00101-014-2305-z

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  • DOI: https://doi.org/10.1007/s00101-014-2305-z

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