P-210 Pneumocephalus complicating a routine thoracic procedure

Hintergrund

Symptomatic pneumocephalus is a rare event after thoracic surgical procedures, and its treatment is not widely recognized.

Material und Methode

We present a rare case of tension pneumocephalus following thoracotomy and resection of the 4^th rib.

Ergebnis

A 66-year-old man with a history of NSCLC and a right lower lobectomy two years ago was presented with a new metastasis in the 4^th right rib.

Partial resection of the 4^th rib at the costovertebral Joint was performed through an anterolateral thoracotomy. No difficulties were encountered during surgery. On 6 POD, the patient was discharged. Two weeks postoperatively, the patient was admitted to the emergency room with headache and alteration in mental status with decreased consciousness. CT-scan showed air in the basilar cisterns and cerebral ventricles. A small loculated pneumothorax was evident in the chest X-ray. The patient was readmitted to the ICU. After interdisciplinary discussion, including a neurosurgeon, a CT-guided tube was placed from dorsal for drainage of a presumed pleural-subarachnoid fistula. Prophylactic antibiotic therapy was started, and the patient's neurologic state improved. However, drainage from the chest was confirmed to be cerebrospinal fluid. Two Re-exploration VATS were performed, and the second VATS was with a patch plasty closure of the assumed pleural-subarachnoid fistula. Twelve days later, the patient had no neurological symptoms, CT-scans revealed no air in subarachnoid space, and the patient was discharged from the hospital.

Schlussfolgerung

Pneumocephalus is a rare but severe complication of thoracotomy. The occurrence of pneumocephalus must be considered when neurologic problems emerge after thoracotomy. Interdisciplinary decision-making, including neurosurgery, is decisive for the treatment. If conservative treatment fails, surgical closure of the fistula should not be delayed.

Publication History

Article published online:
06 September 2021