ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bilsky, M. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Bilsky, M. H.
Related Collections
Right arrow Pleura
Right arrowRelated Article

Ann Thorac Surg 2002;73:1357
© 2002 The Society of Thoracic Surgeons

Correspondence

Reply

Mark H. Bilsky, MDa

a Division of Neurosurgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 71, New York, NY 10021, USA

e-mail: bilskym{at}mskcc.org

To the Editor

We thank Drs Singh and Pathak for bringing to our attention their article on tension pneumocephalus. As noted, tension pneumocephalus may arise within 4 days of thoracotomy, but is often delayed. In our case reports, 1 patient also presented within 4 days. In all of our cases, the pneumocephalus was intraventricular, but Singh and Pathak have demonstrated pneumocephalus over the cerebral convexities. In this situation, I would agree that twist drill hole evacuation of air is a viable treatment. However, as noted in our article, obliteration of the subarachnoid-pleural fistula by operative ligation or resolution of the pneumothorax, resolved the pneumocephalus without the need for an intracranial procedure.

In their article, bone wax and methylmethacrylate are suggested as possible agents to seal a spinal CSF fistula. In my experience, these agents are not adequate to obliterate a fistula, and alternatives should be sought. Intraoperative ligation of a nerve root is most often accomplished by suture ligature or vascular clip application. For tumors extending into the spinal canal, pedicle resection and duraplasty may be required. It was also noted that paralysis may occur by using absorbable gelatin sponge and oxidized cellulose. These are excellent hemostatic agents that are frequently used to control venous bleeding in the neural foramen, but can cause paralysis by excessive mechanical compression. Finally, spinal drainage is not recommended to seal a CSF fistula in the presence of pneumocephalus, as it may result in transtentorial or central brain herniation.


Related Article

Tension pneumocephalus secondary to iatrogenic subarachnoid pleural fistula: certain clarifications
Rana Sandip Singh and Ashis Pathak
Ann. Thorac. Surg. 2002 73: 1357. [Extract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bilsky, M. H.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Bilsky, M. H.
Related Collections
Right arrow Pleura
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS