Open Access
CC BY 4.0 · J Neurol Surg Rep 2025; 86(04): e198-e205
DOI: 10.1055/a-2710-4422
Original Report

Symptomatic Postoperative Pneumocephalus: A Case Series and Review of Management Strategies

Authors

  • Chris Marcellino

    1   Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
    2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
  • Christopher Koo

    1   Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Postoperative (or postprocedural) pneumocephalus is unique from those associated with head injury, spontaneous cerebrospinal fluid leaks, and intracranial infection. Postoperative cranial imaging usually demonstrates a small volume of air that remains in the surgical bed, which is essentially self-limited and resolves over several weeks or less. However, occasionally, surgical defects lead to symptomatic postoperative air entrapment, and severe cases are generally due to one-way valves created by tissue, a mechanism shared with severe traumatic pneumocephalus. In the case where this causes progressive pressurization, this is termed tension pneumocephalus, analogous to its pulmonary counterpart. In the closed adult cranium, the Monroe-Kellie doctrine can be extended to include pneumocephalus if the compressible nature of gas is accounted for. Three illustrative cases are used to highlight common etiologies of postoperative tension pneumocephalus, management strategies, and imaging findings of these collections.

Contributors' Statement

Case review and manuscript revision were performed by C.M. and C.K. Manuscript design and initial draft were produced by C.M.




Publication History

Received: 01 September 2025

Accepted: 21 September 2025

Article published online:
08 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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