Neurocritical Care

, Volume 29, Issue 3, pp 366–373 | Cite as

Oxygen Therapy with High-Flow Nasal Cannula as an Effective Treatment for Perioperative Pneumocephalus: Case Illustrations and Pathophysiological Review

  • Jason L. SiegelEmail author
  • Karen Hampton
  • Alejandro A. Rabinstein
  • Diane McLaughlin
  • Jose L. Diaz-Gomez
Review Article


Pneumocephalus (PNC) is a condition in which when air is trapped inside the intracranial vault. The causes are varied, but include trauma and intracranial surgery. Treatment of PNC typically consists of augmenting patient oxygenation with the attempt of washing out pulmonary nitrogen, creating a gradient in which nitrogen in the intracranial air bubble diffuses out of the lungs via the blood. Though several high flow methods have been tested, the ideal mode of oxygenation has not fully been investigated. Here we present 3 cases of post-operative PNC who we felt were symptomatic from PNC. With administration of high-flow nasal cannula (HFNC), all patients improved both clinically and radiographically within a few hours, faster than in both anecdotal experience and published trials. Due to its steady FiO2 administration, positive pressure, comfort, and low side-effect profile, HFNC may be the ideal mode of oxygen delivery in PNC. We present a review of the physiology of PNC and the characteristics of several oxygen delivery systems to build a case for HFNC in this disease process.


Tension pneumocephalus High-flow nasal cannula Craniectomy Oxygen therapy Arterial oxygen partial pressure 


Compliance with Ethical Standards

Conflict of interest

Dr. Siegel reports no disclosures. Mrs. Hampton reports no disclosures. Dr. Rabinstein reports no disclosures. Ms. McLaughlin reports no disclosures. Dr. Diaz-Gomez reports no disclosures.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Jason L. Siegel
    • 1
    • 2
    Email author
  • Karen Hampton
    • 3
  • Alejandro A. Rabinstein
    • 4
  • Diane McLaughlin
    • 2
  • Jose L. Diaz-Gomez
    • 2
    • 5
    • 6
  1. 1.Department of NeurologyMayo ClinicJacksonvilleUSA
  2. 2.Department of Critical CareMayo ClinicJacksonvilleUSA
  3. 3.Department of Respiratory TherapyMayo ClinicJacksonvilleUSA
  4. 4.Department of NeurologyMayo ClinicRochesterUSA
  5. 5.Department of Anesthesia and Perioperative MedicineMayo ClinicJacksonvilleUSA
  6. 6.Department of NeurosurgeryMayo ClinicJacksonvilleUSA

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