After cranial surgery air or gas may collect within the cranium (pneumocephalus) and can cause symptoms during postoperative recovery.


Risk factors for pneumocephalus:

(1) posterior fossa craniotomy

(2) patient in a head-up posture

(3) use of nitrous oxide (N2O) after sealing of the intracranial space during cranial closure


Clinical findings:

(1) increasing "tightness" to the brain during the surgery

(2) delayed awakening, nonwaking or impaired consciousness after surgery

(3) severe headache after surgery


The diagnosis can be confirmed by taking a lateral skull X-ray or cranial CT scan with the brow up.


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