{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:23:48Z","timestamp":1778631828726,"version":"3.51.4"},"reference-count":55,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Postoperative (or postprocedural) pneumocephalus is unique from those associated with head injury, spontaneous cerebrospinal fluid leaks, and intracranial infection. Postoperative cranial imaging usually demonstrates a small volume of air that remains in the surgical bed, which is essentially self-limited and resolves over several weeks or less. However, occasionally, surgical defects lead to symptomatic postoperative air entrapment, and severe cases are generally due to one-way valves created by tissue, a mechanism shared with severe traumatic pneumocephalus. In the case where this causes progressive pressurization, this is termed tension pneumocephalus, analogous to its pulmonary counterpart. In the closed adult cranium, the Monroe-Kellie doctrine can be extended to include pneumocephalus if the compressible nature of gas is accounted for. Three illustrative cases are used to highlight common etiologies of postoperative tension pneumocephalus, management strategies, and imaging findings of these collections.<\/jats:p>","DOI":"10.1055\/a-2710-4422","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T23:35:38Z","timestamp":1759966538000},"page":"e198-e205","source":"Crossref","is-referenced-by-count":1,"title":["Symptomatic Postoperative Pneumocephalus: A Case Series and Review of Management Strategies"],"prefix":"10.1055","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8046-5902","authenticated-orcid":false,"given":"Chris","family":"Marcellino","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4422-8773","authenticated-orcid":false,"given":"Christopher","family":"Koo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s12028-010-9363-0","article-title":"Pneumocephalus: Case illustrations and review","volume":"13","author":"C M Schirmer","year":"2010","journal-title":"Neurocrit Care"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF01401900","article-title":"The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases","volume":"16","author":"J W Markham","year":"1967","journal-title":"Acta Neurochir (Wien)"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1001\/archsurg.1926.01130050003001","article-title":"Pneumocephalus (intracranial penumatocele or aerocele)","volume":"12","author":"W E Dandy","year":"1926","journal-title":"Arch Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/0899-7071(89)90095-8","article-title":"\u201cSpontaneous\u201d pneumocephalus associated with aerobic bacteremia","volume":"13","author":"T Tanaka","year":"1989","journal-title":"Clin Imaging"},{"issue":"01","key":"ref5","first-page":"8855879","article-title":"Delayed CPAP-induced pneumocephalus and meningitis posttranssphenoidal surgery","volume":"2021","author":"T D'Ignazio","year":"2021","journal-title":"Case Rep Crit Care"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jclinane.2011.12.003","article-title":"Pneumocephalus with BiPAP use after transsphenoidal surgery","volume":"24","author":"J C Kopelovich","year":"2012","journal-title":"J Clin Anesth"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1055\/s-0038-1675588","article-title":"Timing of postoperative CSF leak after endoscopic skull base surgery in patients with obstructive sleep apnea","volume":"80","author":"T M Zimmermann","year":"2019","journal-title":"J Neurol Surg B Skull Base"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jocn.2016.01.012","article-title":"Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery","volume":"29","author":"G A White-Dzuro","year":"2016","journal-title":"J Clin Neurosci"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/00000542-199405000-00009","article-title":"The incidence of pneumocephalus after supratentorial craniotomy. 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Neurosurg Anesthesiol"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1093\/bja\/82.1.117","article-title":"The sitting position in neurosurgery: A critical appraisal","volume":"82","author":"J M Porter","year":"1999","journal-title":"Br J Anaesth"},{"issue":"S 04","key":"ref25","doi-asserted-by":"crossref","first-page":"S291","DOI":"10.1055\/s-0038-1668158","article-title":"Complications of nasoseptal flap reconstruction: A systematic review","volume":"79","author":"P Lavigne","year":"2018","journal-title":"J Neurol Surg B Skull Base"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1213\/01.ANE.0000095153.75625.1F","article-title":"Lumbar puncture associated with pneumocephalus: report of a case","volume":"98","author":"G P Kozikowski","year":"2004","journal-title":"Anesth Analg"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1097\/00000542-198505000-00037","article-title":"Pneumocephalus with headache during spinal anesthesia","volume":"62","author":"L Roderick","year":"1985","journal-title":"Anesthesiology"},{"issue":"01","key":"ref28","first-page":"55","article-title":"Tension pneumocephalus in association with ventriculoperitoneal shunt and congenital bony defect in the mastoid tegmen","volume":"23","author":"T Wada","year":"1995","journal-title":"No Shinkei Geka"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1136\/jnnp.41.4.319","article-title":"Tension pneumocephalus complicating ventriculoperitoneal shunt for cerebrospinal fluid rhinorrhoea: Case report","volume":"41","author":"K Ikeda","year":"1978","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"03","key":"ref30","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1526-4610.2005.05053_2.x","article-title":"Subarachnoid pneumocephalus from epidural steroid injection","volume":"45","author":"J S Hawley","year":"2005","journal-title":"Headache"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1227\/00006123-198208000-00017","article-title":"Tension pneumocephalus after surgical treatment of chronic subdural hematoma: Report of three cases","volume":"11","author":"A M Bremer","year":"1982","journal-title":"Neurosurgery"},{"issue":"02","key":"ref32","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.bpa.2018.06.003","article-title":"Update on nitrous oxide and its use in anesthesia practice","volume":"32","author":"Z Zafirova","year":"2018","journal-title":"Best Pract Res Clin 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Rao","year":"2003","journal-title":"Pituitary"},{"issue":"04","key":"ref36","first-page":"174","article-title":"Frontal sinus osteoma associated with pneumocephalus","volume":"12","author":"B \u00d6nal","year":"2006","journal-title":"Diagn Interv Radiol"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1017\/S002221510014705X","article-title":"Frontal osteoma with spontaneous subdural and intracerebral pneumatocele","volume":"98","author":"D B Mendelsohn","year":"1984","journal-title":"J Laryngol Otol"},{"issue":"06","key":"ref38","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.3171\/jns.1984.60.6.1312","article-title":"Epidermoid tumor presenting as tension pneumocephalus. 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Analg"},{"issue":"03","key":"ref42","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1067\/mhn.2000.107452","article-title":"Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: Predictors of success","volume":"123","author":"J L Zweig","year":"2000","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jocn.2022.02.006","article-title":"The effects of cerebrospinal fluid (CSF) diversion on post-operative CSF leak following extended endoscopic anterior skull base surgery","volume":"98","author":"C W Huo","year":"2022","journal-title":"J Clin Neurosci"},{"issue":"01","key":"ref44","first-page":"78","article-title":"The utility of lumbar drains in modern endoscopic skull base surgery","volume":"23","author":"J Stokken","year":"2015","journal-title":"Curr Opin Otolaryngol Head Neck 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Woodworth","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"07","key":"ref51","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1097\/00005537-200007000-00019","article-title":"Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis","volume":"110","author":"H M Hegazy","year":"2000","journal-title":"Laryngoscope"},{"key":"ref52","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.wneu.2017.07.075","article-title":"Antibiotic prophylaxis in endoscopic endonasal pituitary and skull base surgery","volume":"106","author":"L Milanese","year":"2017","journal-title":"World Neurosurg"},{"issue":"05","key":"ref53","doi-asserted-by":"crossref","first-page":"501","DOI":"10.3109\/02688699308995072","article-title":"Antibiotic prophylaxis in unrepaired CSF fistulae","volume":"7","author":"M S Eljamel","year":"1993","journal-title":"Br J 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