Hüseyin TOMAN, Uğur ÖZDEMİR, HASAN ALİ KİRAZ, Nurettin LÜLECİ

Ozon tedavisi sonrası şiddetli baş ağrısı: Pnömosefali

Pnömosefali kranial kavitede havanın olmasıdır. Pnömosefali epidural anestezi veya epidural steroid enjeksiyonu sırasında yanlışlıkla duranın delinmesi ile meydana gelebilir. Olgumuz 41 yaşında kadın hasta, lomber disk hernisi tanısı ile opere olmuş fakat şikayetleri devam ediyordu başarısız bel cerrahisi sendromu olduğu düşünüldü. Ameliyathanede sedoanaljezi yapılarak steril koşullarda ve skopi altında RACZ kateteri kaudal bölgeden epidural alana yerleştirildi. İlk olarak Madrid deklarasyonu doğrultusunda 20 ug/ml konsantrasyon ve 5 ml hacimde oksijen-ozon karışımı epidural aralığa verildi. Perkütan epidural nöroplasti için 5 dakika sonra 1500 Ünite hiyalüronidaz, %0.25 bupivakain + 80 mg triamsinolon kateterden yapıldı. İşlem sonrası hasta sedyeye alınır iken şiddetli baş ağrısı ve mide bulantısı şikayeti oldu. Hemen bilgisayarlı beyin tomografisi çekildi ve pnömosefali ile uyumlu hava, sağ lateral ventrikül frontal boynuzu, interhemisferik fissür ve süperior serebellar sisternada gözlendi. Hasta Trendelenburg pozisyonuna getirildi ve intravenöz sıvı verildi. Tedavi olarak analjezikler verildi ve yatak istirahati tavsiye edildi. Hasta ikinci gününde taburcu edildi. Baş ağrısı ve şikayetleri bir hafta içinde kayboldu. Bu yazıda başarısız bel cerrahisi sonrası, medikal ozon tedavisinin bir komplikasyonu olarak gelişen pnömosefaliyi literatür bilgileri ışığında tartışmaya çalıştık

Severe headache following ozone therapy: Pneumocephalus

Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen–ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data

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