Symptomatic Pneumocephalus after Spinal Intradural Tumor Surgery

We report a patient who developed symptomatic pneumocephalus after surgery for a spinal intradural tumor. A 30-yearold man presented with low back pain and leg pain was presented. Magnetic resonance image (MRI) demonstrated an welldemarcated intradural extramedullary tumor at the L3-4. The mass had little adhesion rootlets at its base. So, we achieved en-bloc total resection without any difficulty. The patient had no postoperative problems immediately after the surgery such as cerebrospinal fluid (CSF) leakage. However, he began to suffer from headache and restlessness about 8 hours after sitting position. Computed tomography (CT) scan revealed pneumocephalus in bilateral sylvian cistern and basal cistern. He was successfully managed conservatively. Although not being CSF leakage or fistula, pneumocephalus developed especially after removal of intradural extramedullary tumor in spine. We think that the air might be entrapped into surgical cavity when tumor burden was en-bloc removed. When the patient was in upright position, subarachnoid air migrated from the spine into the brain. (J Kor Neurotraumatol Soc 2008;4:101-104)