metricas
covid
Buscar en
Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
Toda la web
Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case a...
Journal Information

Statistics

Follow this link to access the full text of the article

Case report
Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case and literature review
Neumoencéfalo: una inusual complicación de la artrodesis lumbar. Caso clínico y revision de la literatura
C. Andarcia-Bañuelosa,
Corresponding author
candarciab@gmail.com

Corresponding author.
, P. Cortés-Garcíab, M.U. Herrera-Pérezc, B. Deniz-Rodríguezb
a Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
b Cirugía Ortopédica, Unidad de Cirugía de Columna, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
c Cirugía Ortopédica, Unidad de Cirugía de Pie y Tobillo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
Read
1542
Times
was read the article
385
Total PDF
1157
Total HTML
Share statistics
 array:24 [
  "pii" => "S1988885615000401"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2015.04.006"
  "estado" => "S300"
  "fechaPublicacion" => "2015-07-01"
  "aid" => "498"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:222-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 147
    "formatos" => array:2 [
      "HTML" => 86
      "PDF" => 61
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S188844151400085X"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2014.04.007"
      "estado" => "S300"
      "fechaPublicacion" => "2015-07-01"
      "aid" => "498"
      "copyright" => "SECOT"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:222-6"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 294
        "formatos" => array:3 [
          "EPUB" => 7
          "HTML" => 244
          "PDF" => 43
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Nota cl&#237;nica</span>"
        "titulo" => "Neumoenc&#233;falo&#58; una inusual complicaci&#243;n de la artrodesis lumbar&#46; Caso cl&#237;nico y revision de la literatura"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "222"
            "paginaFinal" => "226"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Pneumocephalus&#58; An unusual complication of lumbar arthrodesis&#46; A clinical case and literature review"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0025"
            "etiqueta" => "Figura 5"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr5.jpeg"
                "Alto" => 677
                "Ancho" => 1500
                "Tamanyo" => 139675
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A&#41; Rx lumbar postoperatoria&#59; proyecciones AP y lateral&#46; B&#41; TAC lumbar&#59; corte axial L4&#46; C&#41; TAC lumbar&#59; corte axial L5&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Andarcia-Ba&#241;uelos, P&#46; Cort&#233;s-Garc&#237;a, M&#46;U&#46; Herrera-P&#233;rez, B&#46; Deniz-Rodr&#237;guez"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Andarcia-Ba&#241;uelos"
              ]
              1 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Cort&#233;s-Garc&#237;a"
              ]
              2 => array:2 [
                "nombre" => "M&#46;U&#46;"
                "apellidos" => "Herrera-P&#233;rez"
              ]
              3 => array:2 [
                "nombre" => "B&#46;"
                "apellidos" => "Deniz-Rodr&#237;guez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885615000401"
          "doi" => "10.1016/j.recote.2015.04.006"
          "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/S1988885615000401?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151400085X?idApp=UINPBA00004N"
      "url" => "/18884415/0000005900000004/v1_201506151457/S188844151400085X/v1_201506151457/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1988885615000346"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2014.09.013"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "541"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:227-37"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 139
      "formatos" => array:2 [
        "HTML" => 84
        "PDF" => 55
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Intra- and extracapsular hip fractures in the elderly&#58; Two different pathologies&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "227"
          "paginaFinal" => "237"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fracturas de cadera intra- y extracapsulares en mayores&#58; &#191;dos enfermedades distintas&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;L&#46; Dinamarca-Montecinos, N&#46; Prados-Olleta, R&#46; Rubio-Herrera, A&#46; Castell&#243;n-S&#225;nchez del Pino, A&#46; Carrasco-Buvinic"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "Dinamarca-Montecinos"
            ]
            1 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Prados-Olleta"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Rubio-Herrera"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Castell&#243;n-S&#225;nchez del Pino"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Carrasco-Buvinic"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441514002008"
        "doi" => "10.1016/j.recot.2014.09.009"
        "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/S1888441514002008?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000346?idApp=UINPBA00004N"
    "url" => "/19888856/0000005900000004/v1_201506100052/S1988885615000346/v1_201506100052/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1988885615000383"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2015.04.004"
    "estado" => "S300"
    "fechaPublicacion" => "2015-07-01"
    "aid" => "546"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2015;59:215-21"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 140
      "formatos" => array:2 [
        "HTML" => 61
        "PDF" => 79
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Research</span>"
      "titulo" => "Hyaluronic acid effect on adipose-derived stem cells&#46; Biological <span class="elsevierStyleItalic">in vitro</span> evaluation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "215"
          "paginaFinal" => "221"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Efecto del &#225;cido hialur&#243;nico sobre c&#233;lulas madre mesenquimales derivadas de tejido adiposo&#46; Evaluaci&#243;n biol&#243;gica <span class="elsevierStyleItalic">in vitro</span>"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 2000
              "Ancho" => 2692
              "Tamanyo" => 152290
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CD44 expression in ASC by flow cytometry after 7 days culture &#177;1<span class="elsevierStyleHsp" style=""></span>mg&#47;ml HA&#46; The white profile is of the cells incubated without anti-CD44 antibody &#40;negative control of fluorescence&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Moreno, A&#46; Mart&#237;nez, S&#46; Olmedillas, S&#46; Bello, F&#46; de Miguel"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Moreno"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Mart&#237;nez"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Olmedillas"
            ]
            3 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Bello"
            ]
            4 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "de Miguel"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441514002276"
        "doi" => "10.1016/j.recot.2014.10.004"
        "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/S1888441514002276?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000383?idApp=UINPBA00004N"
    "url" => "/19888856/0000005900000004/v1_201506100052/S1988885615000383/v1_201506100052/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Pneumocephalus&#58; An unusual complication of lumbar arthrodesis&#46; A clinical case and literature review"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "222"
        "paginaFinal" => "226"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "C&#46; Andarcia-Ba&#241;uelos, P&#46; Cort&#233;s-Garc&#237;a, M&#46;U&#46; Herrera-P&#233;rez, B&#46; Deniz-Rodr&#237;guez"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "C&#46;"
            "apellidos" => "Andarcia-Ba&#241;uelos"
            "email" => array:1 [
              0 => "candarciab&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Cort&#233;s-Garc&#237;a"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;U&#46;"
            "apellidos" => "Herrera-P&#233;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "B&#46;"
            "apellidos" => "Deniz-Rodr&#237;guez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Hospital Universitario de Canarias&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cirug&#237;a Ortop&#233;dica&#44; Unidad de Cirug&#237;a de Columna&#44; Hospital Universitario de Canarias&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Cirug&#237;a Ortop&#233;dica&#44; Unidad de Cirug&#237;a de Pie y Tobillo&#44; Hospital Universitario de Canarias&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Neumoenc&#233;falo&#58; una inusual complicaci&#243;n de la artrodesis lumbar&#46; Caso cl&#237;nico y revision de la literatura"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 913
            "Ancho" => 1000
            "Tamanyo" => 134360
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lumbar CT&#59; axial section&#59; right L4 &#40;A&#41; and L5 &#40;B&#41; screws&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pneumocephalus&#44; also known as intracerebral aerocele or pneumatocele is defined as the presence of gas within any intracranial compartment &#40;intraventricular&#44; intraparenchymatous&#44; subarachnoid&#44; subdural and epidural&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> The first case of pneumocephalus was described by Lecat in 1866&#44; but the term <span class="elsevierStyleItalic">pneumocephalus</span> was first used by Wolff in 1914&#44; to describe this infrequent condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2&#44;3</span></a> Pneumocephalus is generally associated to lesions of the cranial vault following trauma&#44; facial trauma and as a consequence of neurosurgery or otolaryngology procedures for the treatment of skull base tumors&#46; It is infrequent after spinal surgery&#44; and in very few occasions it can appear spontaneously&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> A large number of factors can contribute to the development of pneumocephalus&#44; among them&#44; the position of the head during surgery&#44; the duration of the surgery&#44; the use of nitrous oxide for anesthesia&#44; hydrocephalus&#44; intraoperative osmotherapy&#44; hyperventilation&#44; spinal anesthesia&#44; barotrauma&#44; continuous leak of cerebrospinal fluid &#40;CSF&#41; through a lumbar puncture&#44; epidural anesthesia&#44; infections and neoplasms&#46; The clinical presentation can vary significantly depending on the size and tension of the pneumocephalus&#44; and includes headache&#44; nausea&#44; vomiting&#44; seizing&#44; dizziness and worsening of the neurological condition which may even lead to death&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In clinical practice it is essential to be able to differentiate a &#8220;simple pneumocephalus&#8221; from a tension case&#46; The latter refers to a collection of air at a lower pressure than the outer atmospheric pressure&#44; thus creating a valve mechanism that causes the entry of air and prevents it from escaping&#44; establishing a pressure differential and a cascade of adverse effects for the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of pneumocephalus secondary to posterior vertebral arthrodesis is unknown&#46; There are few reports published of tension pneumocephalus following vertebral spinal surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 41-year-old female&#44; with no relevant pathological history&#44; who had been operated at another center in 2007 for an L4&#8211;L5 disc herniation affecting the root of the left L5 nerve &#40;L4&#8211;L5 lumbar discectomy&#41;&#44; who attended our hospital in October 2009 with a history of left L3&#8211;L4 radiculopathy since November 2008&#46; We obtained a magnetic resonance imaging &#40;MRI&#41; scan which showed a left posterolateral protrusion of the L3&#8211;L4 and L4&#8211;L5 discs&#44; which reduced the foraminal space of the left L3 and L4 roots&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Following this diagnosis we conducted&#44; after a routine preanesthetic evaluation&#44; a posterolateral intersomatic fusion procedure at the L3&#8211;L5 levels&#44; with a mini-open approach &#40;percutaneous&#41; on the left side and open procedure on the right side&#44; using two pedicular 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm screws in L3&#44; 1 right pedicular 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm screw in L4 and two pedicular 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm screws in L5 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There were no apparent complications during surgery&#46; We used a vacuum suction drainage system in the area of the open approach in the surgical field&#44; and observed a mild&#8211;moderate loss of fluid with a bloody-aspect from the start of the postoperative period&#44; compatible with the normal evolution of this kind of surgery&#46; The patient recovered without complications in the immediate postoperative period&#44; but presented hypoesthesia and paresis in the right L5 metamere&#46; After 24<span class="elsevierStyleHsp" style=""></span>h&#44; the patient developed an intense and constant frontal and retro-orbital headache&#44; which worsened when standing&#44; accompanied by photophobia&#44; neck rigidity and dysarthria&#44; with no other associated neurological signs and symptoms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">We obtained urgent vertebral spinal and cranial computed tomography &#40;CT&#41; and MRI scans &#40;<a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a>&#41;&#44; which showed aerial images in the bifrontal subarachnoid space &#40;with left predominance&#41; adjacent to the left medial cerebral artery&#46; The ventricular and cistern system presented a normal size and morphology with no displacement of the midline&#46; No signs of parenchymatous hemorrhage or ischemia were detected&#46; The circle of Willis had permeable vessels with size and morphology within the normal range&#46; There were air bubbles in the epidural space of the lumbar spinal canal&#44; postoperative changes related to L3&#8211;L5 fusion&#44; medialization of the right screws of L4 and L5 &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#44; and no evidence of hematomas or significant collections in the surgical field&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The conclusions of the cranial and vertebral spinal CT and MRI were&#58; bifrontal subarachnoid pneumocephalus with left predominance&#44; originating from the lumbar spinal canal&#59; medialization of the right screws of L4 and L5&#46; No anatomical defects were observed that could have caused the pneumocephalus&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">The prescribed treatment was bed rest&#44; analgesic and antiemetic drugs and hyperhydration&#44; in addition to interruption of the suction drainage&#46; We conducted continuous neurological evaluation and obtained a new cranial CT&#44; which showed no changes in the first 48<span class="elsevierStyleHsp" style=""></span>h&#46; After 48<span class="elsevierStyleHsp" style=""></span>h&#44; the patient began to show rapid and progressive clinical and radiographic improvement until the full disappearance of the neurological symptoms associated to pneumocephalus after 1 week&#44; with normalization of the imaging studies after 9 days&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Two weeks after recovering&#44; the patient underwent a new intervention&#44; this time under electrophysiological monitoring&#46; Using a right posterior lumbar Wiltse approach we proceeded to remove the right L4 and L5 pedicular screws&#44; and replace them &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41; under electrophysiological monitoring &#40;two new 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>mm screws&#41;&#44; along with right L4&#8211;L5 hemilaminectomy and search for signs of dural damage&#46; We found a dural lesion in the right L5 root at the level of the shoulder&#44; approximately 0&#46;5<span class="elsevierStyleHsp" style=""></span>mm in length&#44; which was the origin of the air entry which caused the pneumocephalus&#44; as well as a severe intradural lesion in the right L5 root&#44; with no electrophysiological response&#44; so we proceeded to release it up to an extraforaminal level and seal the dural defect with Tissucol<span class="elsevierStyleSup">&#174;</span> &#40;Baxter&#44; Illinois&#44; USA&#41; fibrin adhesive&#46; The postoperative period elapsed without incidents&#46; The patient presented a progressive and full recovery of the sensory deficit and a partial recovery of the L5 paresis after 6 months&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">A considerable number of etiologies can cause the formation of a pneumocephalus&#59; the most relevant are summarized and classified in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Craniotomies represent the most frequent cause of this disease&#46; A certain amount of pneumocephalus cases are an inevitable result of this intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;6</span></a> Reasoner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> reported that 66&#37; of postcraniotomy CT studies showed between 5&#37; and 10&#37; of the intracranial volume occupied by air in at least 1 axial section of the CT&#46; Although generally asymptomatic&#44; pneumocephalus cases with a larger volume have been linked to symptoms like postoperative lethargy&#44; headache&#44; confusion&#44; hemiparesis and paralysis of the 6th cranial nerve&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Less frequently&#44; pneumocephalus may present as complication of an intervention on or fracture of the paranasal sinuses and skull base&#44; insertion of a ventricular-peritoneal bypass&#44; cranial fractures with dural lacerations&#44; following drainage of subdural hematomas&#44; and as a consequence of different types of tumors in this anatomical region&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Different diagnostic procedures&#44; mostly harmless&#44; such as lumbar puncture&#44; ventriculostomy and spinal anesthesia can cause the passage of air by an intrathecal route and lead to a significant pneumocephalus&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Barotrauma secondary to rapid changes in air pressure can turn benign&#44; subclinical cases of pneumocephalus into symptomatic of tension pneumocephalus which require urgent treatment and evacuation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The reported incidence of postoperative CSF fistulas as a complication of spinal surgery&#44; can reach 5&#37;&#46; However&#44; cases complicated by pneumocephalus are rare and their frequency is unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Pneumocephalus is an infrequent but severe complication of spinal surgery&#44; and its management and physiopathology are not fully known&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In the present case&#44; the physiopathology of pneumocephalus can only be explained by the use of a vacuum drainage system after a posterior lumbar arthrodesis which allowed the passage of air into the subarachnoid space through an iatrogenic dural defect that went unnoticed during surgery&#46; There have been reports of cases in which a drainage system led to the formation of a valve-type mechanism which allowed the entry of air into the cranial&#47;spinal subarachnoid space but prevented its exit&#44; generally among postoperative patients who remained in a decubitus position of over 30&#176;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">From a technical standpoint&#44; we consider that a hermetic dural closure through different surgical methods&#44; such as the use of fibrin&#44; albumin and collagen tissue adhesives and glutaraldehyde glues&#44; minimizes the risk of this complication&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In common clinical practice&#44; pneumocephalus with a spinal origin is usually associated to fractures caused by a spinal trauma&#44; penetrating lesions&#44; tumors&#44; infections or iatrogenic causes&#44; including&#44; as previously mentioned&#44; certain diagnostic and therapeutic methods&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the majority of patients with pneumocephalus&#44; a conservative treatment&#44; consisting in bed rest&#44; hyperhydration&#44; analgesics&#44; sedatives and antiemetics&#44; is normally sufficient&#44; and the symptoms are progressively resolved after 1&#8211;3 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Pneumocephalus is a rare but potentially severe complication of spinal surgery&#44; in most cases related to accidental dural tear during surgery&#46; The majority of these air pockets are small&#44; behave benignly&#44; and respond to conservative therapy&#46; However&#44; in some cases they may behave as any other space-occupying lesion&#46; A high degree of clinical suspicion is required to establish the correct diagnosis and treatment&#44; avoiding the progression of the collection&#44; and thus preventing unwanted morbidity and mortality&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The complex field of spinal surgery has found it particularly difficult to reach a constructive consensus describing these undesired and unforeseen events&#44; which appear during or after the surgical intervention&#46; We consider it extremely important to make further efforts to understand the physiopathology of the complications of spinal surgery&#44; thus minimizing their incidence&#44; and to disseminate their knowledge&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Level of evidence</span><p id="par0105" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">V</span>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Protection of people and animals</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data&#46;</p></span></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres521645"
          "titulo" => "Abstract"
          "secciones" => array:3 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Case report"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Discussion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec542228"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres521644"
          "titulo" => "Resumen"
          "secciones" => array:3 [
            0 => array:1 [
              "identificador" => "abst0020"
            ]
            1 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Caso cl&#237;nico"
            ]
            2 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Discusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec542229"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Treatment"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Level of evidence"
        ]
        10 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2014-02-15"
    "fechaAceptado" => "2014-04-05"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec542228"
          "palabras" => array:4 [
            0 => "Pneumocephalus"
            1 => "Post-surgical complication"
            2 => "Posterior lumbar arthrodesis"
            3 => "Dural tear"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec542229"
          "palabras" => array:4 [
            0 => "Neumoenc&#233;falo"
            1 => "Complicaci&#243;n posquir&#250;rgica"
            2 => "Artrodesis lumbar posterior"
            3 => "Lesi&#243;n dural"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pneumocephalus is an uncommon but serious complication of spinal surgery and its management and pathophysiology are not widely recognized&#46; The incidence of symptomatic tension pneumocephalus secondary to posterior spinal arthrodesis is unknown&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The case is reported of a rare case of a 41-year-old woman with diagnosis of L3&#8211;L4&#44; L4&#8211;L5 disc disease and left disc herniation L4&#8211;L5&#46; A posterior spinal arthrodesis L3&#8211;L5&#44; L3&#8211;L4 and L4&#8211;L5 discectomies and release of the left L5 root&#44; was performed without apparent complications&#46; Twenty-four hours after surgery the patient developed generalized headache&#44; neck stiffness&#44; and dysarthria&#46; MRI and CT scans revealed a huge pneumocephalus in the subarachnoid space&#44; predominantly in the left frontal lobe without midline shift&#44; which originated in the lumbar spinal canal&#46; The patient was treated conservatively&#44; with progressive neurological improvement after 72<span class="elsevierStyleHsp" style=""></span>h&#44; and clinical and radiological normalization after 7 days&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pneumocephalus is a rare but potentially serious complication of spine surgery related in most cases with inadvertent dural tear during the operation&#46; Most collections are small&#44; behave benign&#44; and respond to conservative therapy&#46; In the present case&#44; an inadvertent dural tear&#44; produced a pneumocephalus&#46; A high degree of suspicion is needed to make the diagnosis&#44; prompt treatment&#44; as well as remedying the source of air to prevent unwanted morbidity and mortality&#46;</p></span>"
        "secciones" => array:3 [
          0 => array:1 [
            "identificador" => "abst0005"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Case report"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Discussion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El neumoenc&#233;falo es una complicaci&#243;n poco frecuente pero grave de la cirug&#237;a de la columna vertebral&#44; su manejo y fisiopatolog&#237;a no es ampliamente conocida&#46; La incidencia de neumoenc&#233;falo sintom&#225;tico a tensi&#243;n&#44; secundario a una artrodesis vertebral posterior es desconocida&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso cl&#237;nico</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de una paciente mujer de 41 a&#241;os de edad&#44; con diagn&#243;stico de discopat&#237;a L3-L4&#44; L4-L5 y hernia discal izquierda L4-L5&#46; Se realiz&#243; una artrodesis vertebral posterior L3-L5&#44; discectom&#237;as L3-L4 y L4-L5 y liberaci&#243;n de la ra&#237;z L5 izquierda&#44; sin complicaciones aparentes&#46; Transcurridas 24<span class="elsevierStyleHsp" style=""></span>h despu&#233;s de la cirug&#237;a&#44; la paciente inicia cuadro de cefalea generalizada de fuerte intensidad&#44; rigidez de nuca y disartria&#46; Se realizan TAC y RMN que muestran un enorme neumoenc&#233;falo en el espacio subaracnoideo&#44; a predominio del l&#243;bulo frontal izquierdo&#44; sin desplazamiento de la l&#237;nea media&#44; con origen en el conducto raqu&#237;deo lumbar&#46; La paciente fue tratada de forma conservadora&#44; presentando a partir de las 72<span class="elsevierStyleHsp" style=""></span>h mejor&#237;a neurol&#243;gica progresiva&#44; hasta la normalizaci&#243;n cl&#237;nica y radiol&#243;gica despu&#233;s de 7 d&#237;as&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusi&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El neumoenc&#233;falo es una complicaci&#243;n rara pero potencialmente grave de la cirug&#237;a de columna&#44; relacionada en la mayor&#237;a de los casos con desgarro dural accidental durante la cirug&#237;a&#46; La mayor&#237;a de las colecciones son peque&#241;as&#44; se comportan de forma benigna&#44; y responden al tratamiento conservador&#46; En un gran n&#250;mero de pacientes&#44; puede comportarse como cualquier lesi&#243;n ocupante de espacio&#44; por lo que se necesita un alto grado de sospecha cl&#237;nica para hacer el diagn&#243;stico y tratamiento oportuno&#44; y prevenir la morbimortalidad no deseadas&#46;</p></span>"
        "secciones" => array:3 [
          0 => array:1 [
            "identificador" => "abst0020"
          ]
          1 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Caso cl&#237;nico"
          ]
          2 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Discusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Andarcia-Ba&#241;uelos C&#44; Cort&#233;s-Garc&#237;a P&#44; Herrera-P&#233;rez MU&#44; Deniz-Rodr&#237;guez B&#46; Neumoenc&#233;falo&#58; una inusual complicaci&#243;n de la artrodesis lumbar&#46; Caso cl&#237;nico y revision de la literatura&#46; Rev Esp Cir Ortop Traumatol&#46; 2015&#59;59&#58;222&#8211;226&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 922
            "Ancho" => 1001
            "Tamanyo" => 99708
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Postoperative lumbar Rx&#46; AP and lateral projections&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 573
            "Ancho" => 1800
            "Tamanyo" => 169339
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Cranial CT&#59; axial section&#46; &#40;B&#41; Cranial MRI&#59; T2 axial section&#46; &#40;C&#41; Cranial MRI&#59; T1 sagittal section&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 545
            "Ancho" => 500
            "Tamanyo" => 76543
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lumbar spinal CT&#59; sagittal section&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 913
            "Ancho" => 1000
            "Tamanyo" => 134360
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Lumbar CT&#59; axial section&#59; right L4 &#40;A&#41; and L5 &#40;B&#41; screws&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 677
            "Ancho" => 1500
            "Tamanyo" => 149703
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Postoperative lumbar Rx&#59; AP and lateral projections&#46; &#40;B&#41; Lumbar CT&#59; L4 axial section&#46; &#40;C&#41; Lumbar CT&#59; L5 axial section&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">1&#46; Defects of the cranial vault</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Postoperative</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Craniotomy&#44; insertion of ventricular bypass&#44; drainage of chronic subdural hematomas&#44; endoscopic or transsphenoidal surgery in the paranasal sinuses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Post-traumatic</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Open fracture with dural laceration&#44; fracture of the paranasal sinuses or skull base&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Congenital defects of the cranial vault or the <span class="elsevierStyleItalic">Tegmen tympani</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tumors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">2&#46; Infections by gas-producing microorganisms</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">3&#46; Barotrauma</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">4&#46; Complication from other invasive procedures</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Spinal anesthesia&#44; lumbar puncture&#44; ventriculostomy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">5&#46; Complication of spinal surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab842409.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Etiology of pneumocephalus&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumocephalus&#58; case illustrations and review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;M&#46; Schirmer"
                            1 => "C&#46;B&#46; Heilman"
                            2 => "A&#46; Bhardwaj"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12028-010-9363-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurocrit Care"
                        "fecha" => "2010"
                        "volumen" => "13"
                        "paginaInicial" => "152"
                        "paginaFinal" => "158"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20405340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptomatic tension pneumocephalus&#58; an unusual post-operative complication of posterior spinal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Turgut"
                            1 => "O&#46; Aky&#252;z"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jocn.2006.02.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Neurosci"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "paginaInicial" => "666"
                        "paginaFinal" => "668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17532503"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptomatic spontaneous pneumocephalus after spinal fusion for spondylolisthesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Ayberk"
                            1 => "M&#46;E&#46; Yaman"
                            2 => "M&#46;F&#46; Ozveren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jocn.2009.10.033"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Neurosci"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "934"
                        "paginaFinal" => "936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20400320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumocephalus secondary to cerebrospinal fluid leak associated with a lumbar pressure ulcer in a man with paraplegia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46;M&#46; Eltorai"
                            1 => "R&#46;E&#46; Montroy"
                            2 => "S&#46;L&#46; Kaplan"
                            3 => "W&#46;H&#46; Ho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Spinal Cord Med&#46;"
                        "fecha" => "2003"
                        "volumen" => "26"
                        "paginaInicial" => "262"
                        "paginaFinal" => "269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14997970"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The incidence of pneumocephalus after supratentorial craniotomy&#46; Observations on the disappearance of intracranial air"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;K&#46; Reasoner"
                            1 => "M&#46;M&#46; Todd"
                            2 => "F&#46;L&#46; Scamman"
                            3 => "D&#46;S&#46; Warner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesthesiology"
                        "fecha" => "1994"
                        "volumen" => "80"
                        "paginaInicial" => "1008"
                        "paginaFinal" => "1012"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8017640"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tension pneumocephalus after evacuation of chronic subdural hematoma and subsequent treatment with continuous lumbar subarachnoid infusion and craniostomy drainage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Caron"
                            1 => "C&#46; Worthington"
                            2 => "G&#46; Bertrand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1985"
                        "volumen" => "16"
                        "paginaInicial" => "107"
                        "paginaFinal" => "110"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3974807"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lumbar puncture associated with pneumocephalus&#58; report of a case"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;P&#46; Kozikowski"
                            1 => "S&#46;P&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anesth Analg"
                        "fecha" => "2004"
                        "volumen" => "98"
                        "paginaInicial" => "524"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14742399"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumocephalus as a consequence of barotrauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;W&#46; Goldmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1986"
                        "volumen" => "255"
                        "paginaInicial" => "3154"
                        "paginaFinal" => "3156"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3702028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;F&#46; Petzler"
                            1 => "C&#46;B&#46; Wilson"
                            2 => "J&#46;R&#46; Youmans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "fecha" => "1982"
                        "paginaInicial" => "2224"
                        "editorial" => "WB Saunders"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of the use of BioGlue in neurosurgical procedures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Kumar"
                            1 => "N&#46;F&#46; Maartens"
                            2 => "A&#46;H&#46; Kaye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Neurosci"
                        "fecha" => "2003"
                        "volumen" => "10"
                        "paginaInicial" => "661"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14592612"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000005900000004/v1_201506100052/S1988885615000401/v1_201506100052/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7599"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case report"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005900000004/v1_201506100052/S1988885615000401/v1_201506100052/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885615000401?idApp=UINPBA00004N"
]
Article information
ISSN: 19888856
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 3 0 3
2024 October 12 4 16
2024 September 23 4 27
2024 August 22 4 26
2024 July 15 3 18
2024 June 25 1 26
2024 May 18 7 25
2024 April 30 5 35
2024 March 29 7 36
2024 February 33 4 37
2024 January 39 5 44
2023 December 28 6 34
2023 November 29 5 34
2023 October 45 5 50
2023 September 25 5 30
2023 August 26 9 35
2023 July 32 4 36
2023 June 34 7 41
2023 May 49 7 56
2023 April 46 2 48
2023 March 21 7 28
2023 February 22 5 27
2023 January 19 6 25
2022 December 21 16 37
2022 November 17 8 25
2022 October 28 7 35
2022 September 15 6 21
2022 August 23 9 32
2022 July 17 14 31
2022 June 17 12 29
2022 May 12 6 18
2022 April 10 8 18
2022 March 15 6 21
2022 February 19 7 26
2022 January 30 5 35
2021 December 31 9 40
2021 November 32 9 41
2021 October 16 6 22
2021 September 12 8 20
2021 August 35 4 39
2021 July 12 11 23
2021 June 14 9 23
2021 May 9 6 15
2021 April 22 14 36
2021 March 17 9 26
2021 February 9 11 20
2021 January 13 12 25
2018 February 10 2 12
2018 January 15 2 17
2017 December 11 0 11
2017 November 17 3 20
2017 October 6 5 11
2017 September 13 3 16
2017 August 6 3 9
2017 July 7 4 11
2016 December 0 4 4
2016 November 0 2 2
2016 September 0 2 2
2016 August 0 1 1
2016 July 0 1 1
2016 June 0 1 1
2016 May 0 6 6
2016 April 0 4 4
2016 March 0 1 1
2016 February 0 4 4
2016 January 0 4 4
2015 December 0 2 2
2015 October 0 1 1
2015 September 0 4 4
2015 August 1 1 2
2015 July 0 1 1
Show all

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos