Image of the month
Haemopneumoencephalus as a complication of transsphenoidal approach
Hemoneumoencéfalo como complicación a abordaje transesfenoidal
V. Moreno-Carbonell
, J. Magno Serrano, P. De Alonso Andrés, F.P. Bueno Villalba
Corresponding author
Servicio Extremeño de Salud, Extremadura, Spain
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2341192923000227" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.09.013" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1391" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:121-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S003493562100270X" "issn" => "00349356" "doi" => "10.1016/j.redar.2021.09.011" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1391" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Anestesiol Reanim. 2023;70:121-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">IMAGEN DEL MES</span>" "titulo" => "Hemoneumoencéfalo como complicación a abordaje transesfenoidal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Haemopneumoencephalus as a complication of transsphenoidal approach" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 966 "Ancho" => 750 "Tamanyo" => 118578 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Corte axial de TC craneal del paciente tras intervención.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Moreno-Carbonell, J. Magno Serrano, P. De Alonso Andrés, F.P. Bueno Villalba" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Moreno-Carbonell" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magno Serrano" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "De Alonso Andrés" ] 3 => array:2 [ "nombre" => "F.P." "apellidos" => "Bueno Villalba" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192923000227" "doi" => "10.1016/j.redare.2021.09.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000227?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493562100270X?idApp=UINPBA00004N" "url" => "/00349356/0000007000000002/v1_202301310659/S003493562100270X/v1_202301310659/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192923000252" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.11.006" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1403" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:123" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Difficult airway in Eagle’s syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "123" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vía aérea difícil en el síndrome de Eagle" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 868 "Ancho" => 905 "Tamanyo" => 70056 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0130" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">red arrow indicates the left styloid process 83<span class="elsevierStyleHsp" style=""></span>mm in length. Green arrow indicates stylohyoid ligament calcification.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Blasco Mariño, J.M. Vázquez, E. Cardona Calvo, A. Biarnes-Suñé" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Blasco Mariño" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Vázquez" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Cardona Calvo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Biarnes-Suñé" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621002991" "doi" => "10.1016/j.redar.2021.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621002991?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000252?idApp=UINPBA00004N" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000252/v1_202303141745/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192923000197" "issn" => "23411929" "doi" => "10.1016/j.redare.2021.06.007" "estado" => "S300" "fechaPublicacion" => "2023-02-01" "aid" => "1368" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2023;70:119-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Negative preoperative RT-PCR screening is no guaranty of no SARS-CoV-2 infection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "120" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El cribado preoperatorio negativo mediante RT-PCR no garantiza la no infección por SARS-CoV-2" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Lippi, F. Sanchis-Gomar, B.M. Henry" "autores" => array:3 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Lippi" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Sanchis-Gomar" ] 2 => array:2 [ "nombre" => "B.M." "apellidos" => "Henry" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935621002206" "doi" => "10.1016/j.redar.2021.06.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935621002206?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000197?idApp=UINPBA00004N" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000197/v1_202303141745/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Haemopneumoencephalus as a complication of transsphenoidal approach" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V. Moreno-Carbonell, J. Magno Serrano, P. De Alonso Andrés, F.P. Bueno Villalba" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Moreno-Carbonell" "email" => array:1 [ 0 => "valentinemc88@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magno Serrano" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "De Alonso Andrés" ] 3 => array:2 [ "nombre" => "F.P." "apellidos" => "Bueno Villalba" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Extremeño de Salud, Extremadura, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemoneumoencéfalo como complicación a abordaje transesfenoidal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 966 "Ancho" => 750 "Tamanyo" => 118569 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial cranial CT section of the patient after surgery.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intraventricular pneumocephalus is a rare complication of transsphenoidal approaches. We present the image of an 84-year-old man weighing 72 kg who underwent endoscopic pituitary adenoma resection. The computed tomography (CT) image shows recent postoperative changes following resection of the sellar lesion using the transsphenoidal approach. Major dilatation of the ventricular system can be seen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with a significant amount of pneumoventricle inside, as well as haemoventricle in the occipital horns (yellow circle) and in the fourth ventricle, associated with transependymal oedema. Pneumocephalus bubbles in the frontal and left temporal region (yellow star). Associated with these findings, the patient also had a left parietal trephine hole and occupation of both nostrils and sphenoidal sinus by possible haemostatic material with mucosal thickening of ethmoid cells and maxillary sinuses bilaterally, which are not visualised in the section presented.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Intraventricular pneumocephalus is a rare complication of transsphenoidal approaches. The image shows an 84-year-old man, 72 kg ASA IV, independent for basic activities of daily living (BADL) with a frailty phenotype, who underwent endoscopic excision of a pituitary adenoma (pituitary macroadenoma) grade II Hardy classification. Comorbidities included chronic obstructive pulmonary disease (COPD), heart failure (HF) according to the New York Heart Association (NYHA) class II, hypertrophic cardiomyopathy, chronic left frontoparietal subdural haematoma due to a history of craniocerebral trauma 10 years previously and Parkinson's syndrome. Neurologically, the patient had a Glasgow score (GCS) of 15, normoreactive isochoric pupils, normal cranial nerves, without campimetric alterations, was able to move all four limbs, and with normal strength. He had intelligible dysarthria, without sensory disturbances or dysmetria. Cerebrospinal fluid was not drained during the operation due to intraoperative complications.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pneumocephalus (PC), or intracranial pneumatocele, or aerocele, is defined as the presence of air or gas in any endocranial (intraventricular, intraparenchymal, subarachnoid cisterns), subdural or even epidural compartment<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Lecat first described this condition in 1741, but the term “pneumocephalus” was coined independently by Luckett in 1913 and Wolff in 1914. The term “tension pneumocephalus” was proposed in 1962 by Ectors, Kessler, and Stern. However, it is classified as early PC (first seven days after surgery) vs. delayed PC (after seven days after surgery). It is also classified as acute PC (under 72 h) and delayed PC (72 h or later), although the clinical classification is more relevant: simple PC and tension PC (symptomatic).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Simple cranioencephalic CT is the gold standard in the diagnosis of PC. CT can detect even .55 mL of intracranial air, whereas a skull X-ray requires at least 2 mL. Air has a Hounsfield coefficient of −1000 HU. Magnetic resonance imaging (MRI) can be useful, but is less sensitive than CT, and can sometimes confuse PC with blood products or flow voids.</p><p id="par0025" class="elsevierStylePara elsevierViewall">There are different signs on CT, depending on the location of the aerocele. The “air bubble sign” denotes the presence of multiple aeroceles scattered in different cisterns. Two signs have been identified<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> as characteristic of tension PC: Mount Fuji sign and peaking sign. On the other hand, ventricular air, also known as pneumoventricle or pneumatocele, has typical encephalic expression on CT, known as the angel wing sign of intraventricular pneumocephalus. The angel wing sign has been described earlier in paediatric chest radiography due to tension pneumomediastinum, but not in intracranial imaging<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. McLaughlin's intracranial angel wing sign, a characteristic pattern of intraventricular pneumocephalus, is also seen in the authors' image. It is due to air passage after transsphenoidal surgery, with intraventricular dilatation and intrinsic pressure of the surrounding brain tissue, requiring medical and surgical treatment of symptomatic pneumocephalus. In addition, air is irritant and predisposes to infection. The transependymal oedema referred to in the case described suggests hypertensive hydrocephalus due to haemoventricle (blockage of cerebrospinal fluid outflow) and due to tension pneumoventricle even more so<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 966 "Ancho" => 750 "Tamanyo" => 118569 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial cranial CT section of the patient after surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tension sellar pneumocele: a case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Á. Campero" 1 => "P. Aljer" 2 => "E. Goldschmidt" 3 => "D. Bendersky" 4 => "A. Campero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2152-7806.104404" "Revista" => array:6 [ "tituloSerie" => "Surg Neurol Int." "fecha" => "2012" "volumen" => "3" "paginaInicial" => "S395" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23596554" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subdural tension pneumocephalus following surgery for chronic subdural hematoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Ishiwata" 1 => "K. Fujitsu" 2 => "T. Sekino" 3 => "H. Fujino" 4 => "T. Kubokura" 5 => "K. Tsubone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.1988.68.1.0058" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg." "fecha" => "1988" "volumen" => "68" "paginaInicial" => "58" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3335913" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Angel Wing pneumocephalus Sign</span> following transsphenoidal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.C. McLaughlin" 1 => "K.L. Chaichana" 2 => "W.D. Freeman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neuro-hospitalist." "fecha" => "2019" "volumen" => "9" "paginaInicial" => "116" "paginaFinal" => "117" "itemHostRev" => array:3 [ "pii" => "S0012369220316792" "estado" => "S300" "issn" => "00123692" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000002/v1_202303141745/S2341192923000227/v1_202303141745/en/main.assets" "Apartado" => array:4 [ "identificador" => "70433" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000002/v1_202303141745/S2341192923000227/v1_202303141745/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923000227?idApp=UINPBA00004N" ]
