====== Pneumocephalus treatment ======

A high degree of suspicion is needed to make the diagnosis, prompt treatment, as well as remedying the source of air to prevent unwanted morbidity and mortality
((Andarcia-Bañuelos C, Cortés-García P, Herrera-Pérez MU, Deniz-Rodríguez B.
Pneumocephalus: An unusual complication of lumbar arthrodesis. A clinical case
and literature review. Rev Esp Cir Ortop Traumatol. 2014 Jun 4. pii:
S1888-4415(14)00085-X. doi: 10.1016/j.recot.2014.04.007. [Epub ahead of print]
English, Spanish. PubMed PMID: 24906529.)).
[[Tension pneumocephalus]] usually requires emergent management.
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When [[pneumocephalus]] is due to gas-producing organisms, treatment of the primary [[infection]] is initiated and the pneumocephalus is usually followed.

Treatment of non-infectious simple pneumocephalus depends on whether or not the presence of a [[Cerebrospinal fluid fistula]] is suspected. If there is no leak the gas will be resorbed with time, and if the mass effect is not severe it may simply be followed. If a Cerebrospinal fluid fistula is suspected, management is as with any [[CSF fistula]].

Supplemental oxygen increases the rate of absorption of pneumocephalus.
Treatment of significant or symptomatic post-op pneumocephalus by breathing 100% O2 via a nonrebreather mask increases the rate of resorption
((Gore PA, Maan H, Chang S, et al. Normobaric oxygen therapy strategies in the treatment of postcraniotomy pneumocephalus. J Neurosurg. 2008; 108: 926–929))
((Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and
review. Neurocrit Care. 2010 Aug;13(1):152-8. doi: 10.1007/s12028-010-9363-0.
Review. PubMed PMID: 20405340.
))
(100% FiO2 can be tolerated for 24–48 hours without serious pulmonary toxicity
((Klein J. Normobaric pulmonary oxygen toxicity. Anesth Analg. 1990; 70:195–207))

[[Tension pneumocephalus]] producing significant [[symptom]]s must be evacuated. The urgency is similar to that of an [[intracranial hematoma]]. Dramatic and rapid improvement may occur with the release of gas under pressure. Options include placement of a new twist drill or burr holes, or insertion of a spinal needle through a pre-existing burr hole (e.g. following a craniotomy).

===== References =====