Article
Cerebellar hemorrhage and tension pneumocephalus following resection of a pancoast tumor
Kleinhirnblutung und Spannungspneumenzephalus nach Resektion eines Pancoast-Tumors
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Published: | April 23, 2004 |
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Outline
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Objective
Cerebellar hemorrhage after spinal surgery involving the posterior chest wall and development of subarachnoid-pleural fistulas are well described, but uncommon, complications. We present an unusual case of cerebellar hemorrhage followed by tension pneumocephalus and subsequent bacterial meningitis several days after thoracotomy for resection of a pancoast tumor
Clinical presentation
The post-operative course of the 32-year-old patient was complicated by an impaired level of consciousness and agitation. CCT showed a cerebellar hemorrhage and hydrocephalus caused by compression of the fourth ventricle. Immediate surgical evacuation of the hemorrhage and placement of an external ventricular drain was performed. Respirator therapy maintaining a continuous positive airway pressure was required. During this period the ventricular drain was permanently closed. Following weaning and extubation the patient rapidly deteriorated and became comatose. CCT now demonstrated the ventricular system as well as the subarachnoid space dilated and filled with gas. Gas was also in the cervical spinal subarachnoid space. Relief of intracranial pressure was achieved by aspiration of intracranial air through the ventricular drainage. Recurrent deterioration of consciousness after repeated air aspiration indicated rapid refilling of the ventricles with gas.
Intervention
The patient underwent emergency surgical reexploration of the thoracic resection cavity: Dural lacerations of the nerve roots C8 and Th1 were identified and sealed up.
Conclusions
Cerebellar hemorrhage and tension pneumocephalus must be considered in patients with unexplained neurological deterioration after posterior chest wall resection. This initial presentation of a subarachnoid-pleural fistula with a cerebellar haemorrhage followed by a tension pneumocephalus after discontinuation of a continuous positive airway pressure is unusual. To our knowledge this is the first description of these two uncommon complications in one patient after thoracic spine surgery.