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Vol. 18. Issue 2.
Pages 134-137 (January 2007)
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Vol. 18. Issue 2.
Pages 134-137 (January 2007)
Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: Presentación de un caso y revisión de la literatura
Intraventricular tensión pneumocephalus after transsphenoidal surgery: a case report and literature review
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F. Ruiz-Juretschke
, O. Mateo-Sierra, B. Iza-Vallejo, R. Carrillo-Yagüe
Servicio de Neurocirugía. Hospital General Universitario Gregorio Marañón. Madrid
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Resumen

El neumoencéfalo a tensión (NT) es una complicación rara de los abordajes transesfenoidales. Se describe el caso de una mujer de 37 años intervenida de un adenoma de hipófisis por vía transesfenoidal que presentó rinolicuorrea autolimitada en el postoperatorio. A los tres días la paciente desarrolló un deterioro progresivo de conciencia, amnesia anterógrada y cefalea, detectándose en la TC un NT intraventricular. Se realizó un tratamiento urgente con drenaje ventricular externo bilateral y taponamiento nasal anterior con buena respuesta clínica. De modo diferido se procedió a la revisión del abordaje esfenoidal lográndose el cierre definitivo del defecto dural sin recidiva posterior.

El NT después de la cirugía por vía esfenoidal suele ocurrir tras la aparición de una fístula de LCR debido al sellado incompleto del seno esfenoidal. La colocación de un drenaje lumbar postoperatorio parece predisponer a esta complicación. El enfoque terapéutico combinado del NT mediante drenaje ventricular externo y reparación del seno esfenoidal ofrece un resultado óptimo con una solución rápida para el deterioro neurológico del paciente y evita las recidivas.

Palabras clave:
Fístula de líquido cefalorraquídeo
Drenaje lumbar
Adenoma de hipófisis
Neumoencéfalo
Cirugía transesfenoidal
Summary

Tension pneumocephalus is a rare complication of transsphenoidal approaches. The case of a 37 year old woman with a transsphenoidal resection of a pituitary adenoma who presented self-limited rhinoliquorrhea postoperatively is reported. Three days later the patient developed progressive decreased consciousness, amnesia and headache, showing an intraventricular tension pneumocephalus on CT scan. Urgent treatment with bilateral external ventricular drainage and anterior nasal tamponade was performed with good clinical outcome. Later transsphenoidal sealing of the dural defect was achieved without recurrence.

Tension pneumocephalus following transsphenoidal surgery usually occurs after the presentation of a cerebrospinal fluid leak due to an incomplete sealing of the sphenoid sinus. The postoperative insertion of a lumbar drainage seems to be a predisposing condition for this complication. The combined approach of tension pneumocephalus with external ventricular drainage and repair of the sphenoid sinus offers optimal results solving the acute neurological deterioration and avoiding recurrence.

Keywords:
Cerebrospinal fluid fistula
Lumbar drainage
Pituitary adenoma
Pneumocephalus
Transphenoidal surgery

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