Pneumocephalus Following Subcutaneous Lumbar Fluid Collection Aspiration

Document Type

Conference Proceeding

Publication Date

11-12-2025

Publication Title

Cardiovasc Intervent Radiol

Keywords

oxygen, adult, aged, aspiration, bed rest, case report, clinical article, complication, conference abstract, drug therapy, human, hydration, hypovolemia, intracranial pressure, laminectomy, lumbar puncture, male, meningocele, middle aged, myelography, nausea, pneumocephalus, subcutaneous tissue, surgery, syringe, T2 weighted imaging, therapy

Abstract

Clinical history: A 52-year-old man with history of L4-S1 posterior fusion 4 months ago was referred to IR by a pain specialist for an outpatient lumbar fluid collection aspiration. Pre-procedure axial T2-weighted MRI demonstrates a superficial and deeper collection at the site of prior right laminectomy without obvious communication. Treatment results: An over the needle catheter was placed into the collection and 325ml of fluid was removed. Afterwards, he developed a severe, intractable headache and nausea. Head CT demonstrated a significant amount of pneumocephalus. Neurosurgery was consulted. The patient was managed with IV hydration, supplemental oxygen, and bedrest. There was near-complete resolution of pneumocephalus the next day. Discussion: Pneumocephalus following lumbar puncture/epidural injection has been reported; however, pneumocephalus resulting from lumbar fluid collection aspiration, which was later determined to be a large pseudomeningocele, is quite uncommon. The mechanism by which pneumocephalus occurs varies due to etiology. In this case, we theorize that, as the operator removed the fluid, air was introduced into the pseudomeningocele due to negative pressure from CSF volume depletion and the catheter remaining open to the atmosphere (during emptying/exchanging of the aspiration syringe). Treatment of pneumocephalus can be conservative oxygen supplementation to aid in reabsorption, but surgical intervention may be necessary for those with symptoms of intracranial tension. Take-home points: Pneumocephalus is a possible complication of lumbar fluid collection aspiration, lumbar punctures and myelography. Providers performing drainage of lumbar fluid collections should keep a high index of suspicion for pseudomeningocele/meningocele, especially if the fluid characteristics resemble CSF.

Volume

48

Issue

4

First Page

S704

Find It @ Sladen

Share

COinS