From the Research
Pneumocephalus should be managed with supplemental oxygen therapy, specifically high-flow nasal cannula, to accelerate air resorption and improve clinical outcomes, as evidenced by the most recent and highest quality study 1. Pneumocephalus is a condition characterized by the presence of air or gas within the cranial cavity, typically occurring after head trauma, neurosurgery, or certain medical procedures. It develops when air enters the skull through fractures or surgical openings, replacing cerebrospinal fluid. Symptoms can range from headaches, nausea, and altered mental status to seizures or focal neurological deficits, depending on the amount and location of the air.
Key Considerations
- Most cases of pneumocephalus resolve spontaneously with conservative management, including:
- Bed rest
- Head elevation to 30-45 degrees
- Avoidance of Valsalva maneuvers
- Pain control
- Adequate hydration
- Supplemental oxygen therapy (100% oxygen) may be administered to accelerate air resorption by creating a diffusion gradient, with high-flow nasal cannula being a effective mode of oxygen delivery 1.
- Prophylactic antibiotics might be prescribed if there's a risk of infection, particularly with skull base fractures or CSF leaks.
- Severe cases with tension pneumocephalus, where trapped air causes increased intracranial pressure, require urgent neurosurgical intervention for air evacuation.
Management Strategies
- Regular neurological monitoring and follow-up imaging are essential to ensure resolution.
- The condition typically improves within days to weeks as the body naturally reabsorbs the air and the entry point seals.
- Avoidance of contributing factors, high index of suspicion, and confirmation with neuroimaging are important in attenuating mortality and morbidity 2.
- Hyperbaric oxygenation therapy may also be considered in selective cases to lead to clinical and radiological improvement in patients with pneumocephalus 3.