Abstract
Pneumocephalus following spinal surgery is a rare but significant complication, particularly
in procedures involving durotomy. Its nonspecific presentation can be mistaken for
anesthesia-related effects, delaying diagnosis. We report a 70-year-old female who
underwent D4 laminectomy and excision of a D3–D4 intradural extramedullary tumor.
In the immediate postoperative period, she developed progressively worsening frontal
headache and nausea, unresponsive to standard analgesia. A computed tomography scan
on postoperative day 1 revealed pneumocephalus in the basal cisterns and Sylvian fissures.
Despite no evident cerebrospinal fluid leak after watertight closure or intraoperative
nitrous oxide use, factors such as subtle dural microleaks, intraoperative head elevation,
and the use of a subfascial drain may have contributed to intracranial air entry.
Vacuum activation of the drain, though not confirmed, could not be ruled out. Conservative
management with supine positioning, oxygen therapy, analgesics, and early drain removal
led to full symptom resolution. This case highlights the need for early recognition
of pneumocephalus in patients with severe postoperative headache particularly as headache
severity has been shown to correlate with the extent of pneumocephalus. Heightened
awareness and preventive intraoperative strategies are essential to mitigate this
risk.
Keywords
pneumocephalus - laminectomy - spine surgery - headache
