Study Design: Systematic Review Objective: To systematically review cases of pneumocephalus following spinal procedures and evaluate prognosis and effective treatment options for this pathology. Summary of Background Data: Pneumocephalus is a rare complication of spinal procedures requiring unique strategies for symptom management and treatment. Intracranial air may cause acute decompensation when intracranial pressure rises rapidly, and therefore, early identification of pneumocephalus is crucial for recovery. Methods: A systematic review was performed to interrogate PubMed/MEDLINE for clinical and radiologic presentation of cases of pneumocephalus following spinal procedures. Results: A total of 105 articles were included, with 133 cases of pneumocephalus presenting as a complication of spinal procedures. The most common procedures investigated were epidural injections (38.7%) and decompression surgeries (17.0%). Tension pneumocephalus was reported in 17 cases and conveyed no increased risk of mortality ( P =0.59), ICU admission ( P =0.76), or persistent symptoms ( P =0.71). Patients receiving surgical treatment were significantly more likely to have an ICU stay during their hospital course ( P =0.005) but had no difference in symptom improvement ( P =0.35), radiologic resolution ( P =0.34), or mortality ( P =0.62) compared with medically managed patients. Patients with additional neurological sequelae were also more likely to receive surgery ( P <0.001). Patients with headache were significantly less likely to experience persistent symptoms ( P =0.008), persistent imaging findings ( P =0.01), ICU care ( P <0.001), and mortality ( P =0.04), while altered mental status was associated with significantly greater risk of symptom persistence ( P =0.04), ICU stay ( P <0.001), and mortality ( P =0.049). The overall symptom improvement rate was 86%, and the mortality rate was 5%. Conclusions: Overall prognosis for pneumocephalus as a complication of spinal procedures is favorable. Insights concerning symptom presentation can help spine surgeons improve communication regarding expected outcomes. Level of Evidence: Level IV.
Rajkovic et al. (Mon,) studied this question.