Abstract
References
- Gorissen Z, Hakvoort K, van den Boogaart M, et al. Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury. Acta Neurochir (Wien). 2019;161:361-5.
- Ramsden RT, Block J. Traumatic pneumocephalus. J Laryngol Otol. 1976;90:345-55.
- Wankhade BS, Beniamein MMK, Alrais ZF, et al. What should an intensivist know about pneumocephalus and tension pneumocephalus?. Acute Crit Care. 2023;38:244-8.
- Lee JS, Park YS, Kwon JT, Suk JS. Spontaneous pneumocephalus associated with pneumosinus dilatans. J Korean Neurosurg Soc. 2010;47:395-8.
- Wakefield BT, Brophy BP. Spontaneous pneumocephalus. J Clin Neurosci. 1999;6:174-5.
- Jakhere SG, Yadav DA, Jain DG, Balasubramaniam S. Does the Mount Fuji Sign always signify “tension” pneumocephalus? An exception and a reappraisal. European Journal of Radiology Extra. 2011;78:e5-7.
- Piccirilli M, Anichini G, Cassoni A, et al. Anterior cranial fossa traumas: clinical value, surgical indications, and results-a retrospective study on a series of 223 patients. J Neurol Surg B Skull Base. 2012;73:265-72.
- Kaplanoglu H, Kaplanoglu V, Dilli A, et al. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eurasian J Med. 2013;45:115-25.
- Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int. 2015;6:155.
- Allioui S, Zaimi S, Sninate S, Abdellaoui M. Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus. Radiology Case Rep. 2020;15:1011-3.
- Carneiro AC, Diaz P, Vieira M, et al. Cerebral venous air embolism: a rare phenomenon. Eur J Case Rep Intern Med. 2019;6:001011.
- Hosaka A, Yamaguchi T, Yamamoto F, Shibagaki Y. Cerebral venous air embolism due to a hidden skull fracture secondary to head trauma. Case Rep Neurol Med. 2015;2015:730808.
- Imaging in skull fractures: practice essentials, radiography, computed tomography. https://emedicine.medscape.com/article/343764-overview?form=fpf access date 15.02.2025.
- Tarolli C, Scully MA, Smith AD 3rd. Teaching NeuroImages: unmasking raccoon eyes: a classic clinical sign. Neurology. 2014;83:e58-9.
- Saad M, Mowafy AA, Naser AM, et al. Analysis of moderate and severe traumatic brain injury associated with skull base fracture: a local tertiary center experience. Egypt J Neurosurg. 2024;39:62.
- Le C, Strong EB, Luu Q. Management of anterior skull base cerebrospinal fluid leaks. J Neurol Surg B Skull Base. 2016;77:404-11.
- Herbella FA, Mudo M, Delmonti C, et al. 'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture. Injury. 2001;32:745-7.
- Baugnon KL, Hudgins PA. Skull base fractures and their complications. Neuroimaging Clin N Am. 2014;24:439-65.
- Shafiei M, Aminmansour B, Mahmoodkhani M, et al. Basilar skull fractures and their complications in patients with traumatic brain injury. Korean J Neurotrauma. 2022;19:63-9.
- Naidu B, Vivek V, Visvanathan K, et al. A study of clinical presentation and management of base of skull fractures in our tertiary care centre. Interdisciplinary Neurosurgery 2021;23:100906.
- Togo M, Hoshi T, Matsuoka R, et al. Multiple small hemorrhagic infarcts in cerebral air embolism: a case report. BMC Res Notes. 2017;10:599.
- Field PJ, Hulka F. Multiple systemic venous air emboli after fatal basilar skull fracture. Trauma Case Rep. 2022;38:100608.
- Choi YY, Hyun DK, Park HC, Park CO. Pneumocephalus in the absence of craniofacial skull base fracture. J Trauma. 2009;66:E24-7.
- Červeňák V, Všianský V, Cviková M, et al. Cerebral air embolism: neurologic manifestations, prognosis, and outcome. Front Neurol. 2024;15:1417006.
- Wong SS, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J. 2017;10:797-803.
- Kwon KE, Park NH, Kim SJ, Park JY. Stroke caused by cerebral air embolism after central venous catheter removal: a case report. J Korean Soc Radiol. 2019;80:975-80.
- Giraldo M, Lopera LM, Arango M. Venous air embolism in neurosurgery. Rev Colomb Anestesiol. 2015;43:40-4.
- Rubinstein D, Symonds D. Gas in the cavernous sinus. AJNR Am J Neuroradiol. 1994;15:561-6.
- Alif M, Jalal MJA, Vijayakumar N, et al. Gas in the venous sinus: An incidental finding. Neurol India. 2017;65:878-80.
- Ortega MA, Fraile-Martinez O, García-Montero C, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities. Medicina (Kaunas). 2021;57:864.
- Calverley RK, Dodds WA, Trapp WG, Jenkins LC. Hyperbaric treatment of cerebral air embolism: a report of a case following cardiac catheterization. Can Anaesth Soc J. 1971;18:665-74.
- McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: practical tips for prevention and treatment. J Clin Med. 2016;5:93.
Etiology of Intracranial Pneumocephalus: A Retrospective Comparative Study of Traumatic and Iatrogenic Causes in Emergency Patients
Abstract
Aim: The aim of this study was to retrospectively investigate the traumatic and iatrogenic causes of intracranial pneumocephalus (ICnP) in patients presenting to the emergency department (ED). Additionally, the study sought to evaluate the role of venous air embolism during intravenous (IV) line placement in the development of ICnP.
Material and Method: A total of 462 patients who presented to the ED of a tertiary healthcare center between 2018 and 2024 were retrospectively analyzed. Patients included in the study presented with complaints of head trauma or headache but did not have open cranial wounds, evident basal skull fractures, or a history of intracranial surgery. Non-contrast cranial Computed Tomography (CT) scans were performed on all patients, and the anatomical localization of pneumocephalus as well as the IV line placement status were meticulously recorded. Statistical analyses were conducted using SPSS version 26.0, with a significance level of p<0.05.
Results: ICnP was most commonly detected in the anterior cranial fossa (62%), followed by the middle fossa (24%) and posterior fossa (10%). Among patients with IV lines, air bubbles were observed in 3.45% of the head trauma group and 2.06% of the headache group. In patients without IV lines, these rates were lower, at 1% and 1.67%, respectively. No statistically significant differences were found between age groups or genders (p>0.05). However, a strong association was noted between IV line placement and venous air embolism.
Conclusion: ICnP is commonly associated with venous air embolism occurring during IV line placement and resolves spontaneously within 24 hours in most cases. Our findings indicate that such air bubbles are typically attributed to iatrogenic causes rather than severe pathologies such as basal skull fractures. Avoiding unnecessary further investigations in patients whose air bubbles resolve within the first 24 hours can optimize clinical management and provide a cost-effective approach.
Ethical Statement
This study was approved by the Ordu University Non-Interventional Scientific Research Ethics Committee (Approval number: E-14647249-000-110429, Decision number: 2025/35, Date: 07.02.2025).
References
- Gorissen Z, Hakvoort K, van den Boogaart M, et al. Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury. Acta Neurochir (Wien). 2019;161:361-5.
- Ramsden RT, Block J. Traumatic pneumocephalus. J Laryngol Otol. 1976;90:345-55.
- Wankhade BS, Beniamein MMK, Alrais ZF, et al. What should an intensivist know about pneumocephalus and tension pneumocephalus?. Acute Crit Care. 2023;38:244-8.
- Lee JS, Park YS, Kwon JT, Suk JS. Spontaneous pneumocephalus associated with pneumosinus dilatans. J Korean Neurosurg Soc. 2010;47:395-8.
- Wakefield BT, Brophy BP. Spontaneous pneumocephalus. J Clin Neurosci. 1999;6:174-5.
- Jakhere SG, Yadav DA, Jain DG, Balasubramaniam S. Does the Mount Fuji Sign always signify “tension” pneumocephalus? An exception and a reappraisal. European Journal of Radiology Extra. 2011;78:e5-7.
- Piccirilli M, Anichini G, Cassoni A, et al. Anterior cranial fossa traumas: clinical value, surgical indications, and results-a retrospective study on a series of 223 patients. J Neurol Surg B Skull Base. 2012;73:265-72.
- Kaplanoglu H, Kaplanoglu V, Dilli A, et al. An analysis of the anatomic variations of the paranasal sinuses and ethmoid roof using computed tomography. Eurasian J Med. 2013;45:115-25.
- Dabdoub CB, Salas G, Silveira Edo N, Dabdoub CF. Review of the management of pneumocephalus. Surg Neurol Int. 2015;6:155.
- Allioui S, Zaimi S, Sninate S, Abdellaoui M. Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus. Radiology Case Rep. 2020;15:1011-3.
- Carneiro AC, Diaz P, Vieira M, et al. Cerebral venous air embolism: a rare phenomenon. Eur J Case Rep Intern Med. 2019;6:001011.
- Hosaka A, Yamaguchi T, Yamamoto F, Shibagaki Y. Cerebral venous air embolism due to a hidden skull fracture secondary to head trauma. Case Rep Neurol Med. 2015;2015:730808.
- Imaging in skull fractures: practice essentials, radiography, computed tomography. https://emedicine.medscape.com/article/343764-overview?form=fpf access date 15.02.2025.
- Tarolli C, Scully MA, Smith AD 3rd. Teaching NeuroImages: unmasking raccoon eyes: a classic clinical sign. Neurology. 2014;83:e58-9.
- Saad M, Mowafy AA, Naser AM, et al. Analysis of moderate and severe traumatic brain injury associated with skull base fracture: a local tertiary center experience. Egypt J Neurosurg. 2024;39:62.
- Le C, Strong EB, Luu Q. Management of anterior skull base cerebrospinal fluid leaks. J Neurol Surg B Skull Base. 2016;77:404-11.
- Herbella FA, Mudo M, Delmonti C, et al. 'Raccoon eyes' (periorbital haematoma) as a sign of skull base fracture. Injury. 2001;32:745-7.
- Baugnon KL, Hudgins PA. Skull base fractures and their complications. Neuroimaging Clin N Am. 2014;24:439-65.
- Shafiei M, Aminmansour B, Mahmoodkhani M, et al. Basilar skull fractures and their complications in patients with traumatic brain injury. Korean J Neurotrauma. 2022;19:63-9.
- Naidu B, Vivek V, Visvanathan K, et al. A study of clinical presentation and management of base of skull fractures in our tertiary care centre. Interdisciplinary Neurosurgery 2021;23:100906.
- Togo M, Hoshi T, Matsuoka R, et al. Multiple small hemorrhagic infarcts in cerebral air embolism: a case report. BMC Res Notes. 2017;10:599.
- Field PJ, Hulka F. Multiple systemic venous air emboli after fatal basilar skull fracture. Trauma Case Rep. 2022;38:100608.
- Choi YY, Hyun DK, Park HC, Park CO. Pneumocephalus in the absence of craniofacial skull base fracture. J Trauma. 2009;66:E24-7.
- Červeňák V, Všianský V, Cviková M, et al. Cerebral air embolism: neurologic manifestations, prognosis, and outcome. Front Neurol. 2024;15:1417006.
- Wong SS, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J. 2017;10:797-803.
- Kwon KE, Park NH, Kim SJ, Park JY. Stroke caused by cerebral air embolism after central venous catheter removal: a case report. J Korean Soc Radiol. 2019;80:975-80.
- Giraldo M, Lopera LM, Arango M. Venous air embolism in neurosurgery. Rev Colomb Anestesiol. 2015;43:40-4.
- Rubinstein D, Symonds D. Gas in the cavernous sinus. AJNR Am J Neuroradiol. 1994;15:561-6.
- Alif M, Jalal MJA, Vijayakumar N, et al. Gas in the venous sinus: An incidental finding. Neurol India. 2017;65:878-80.
- Ortega MA, Fraile-Martinez O, García-Montero C, et al. A general overview on the hyperbaric oxygen therapy: applications, mechanisms and translational opportunities. Medicina (Kaunas). 2021;57:864.
- Calverley RK, Dodds WA, Trapp WG, Jenkins LC. Hyperbaric treatment of cerebral air embolism: a report of a case following cardiac catheterization. Can Anaesth Soc J. 1971;18:665-74.
- McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air embolism: practical tips for prevention and treatment. J Clin Med. 2016;5:93.
Details
| Primary Language | English |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery) |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | May 9, 2025 |
| Submission Date | March 4, 2025 |
| Acceptance Date | April 9, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
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