Pneumocephalus induced isolated oculomotor palsy :Case report and literature review

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 22; p. 100826
• Main Authors: Alturkistani, Abdulellah, Altuhayni, Khalid, Alluhaybi, Abdulelah A., Alotaibi, Fahad E.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-12-2020; Elsevier
• Subjects: Interpeduncular cistern; Oculomotor palsy; Pneumocephalus; CT; EVD; MRI; CSF; Pneumocephalus; Oculomotor palsy; Interpeduncular cistern
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2020.100826

•A 3-year-old girl developed pneumocephalus after undergoing a craniotomy.•The pneumocephalus later induced oculomotor palsy.•High-flow oxygen and conservative measures resolved the oculomotor palsy.
Defined as the presence of air or gas in the cranial cavity, pneumocephalus is attributable to multiple etiologies, including trauma, infection, and neurosurgical procedures. While pneumocephalus-induced cranial neuropathy is extremely uncommon, particularly in the pediatric population, we report the first pediatric case of isolated oculomotor nerve palsy caused by iatrogenic pneumocephalus in the interpeduncular cistern.
A 3-year-old girl diagnosed with a posterior fossa tumor underwent surgical resection, which was complicated by transient isolated oculomotor palsy. Imaging studies revealed pneumocephalus in the interpeduncular cistern. The patient was treated with high-flow oxygen and conservative measures that resolved the oculomotor palsy resolved within 6 h.
This is the first case report of a pediatric patient diagnosed with pneumocephalus-induced oculomotor nerve palsy, a complication that may occur following cranial surgery. While a review of the literature revealed no similar case in pediatric populations, the present and previous reports suggest that pneumocephalus-induced oculomotor nerve palsy may resolve spontaneously with or without conservative treatment.