Han C, Ren ZY, Jiang ZH, Luo YF. Cerebral complications after unilateral biportal endoscopic surgery: A case report. World J Clin Cases 2025; 13(13): 101444 [DOI: 10.12998/wjcc.v13.i13.101444]
Corresponding Author of This Article
Chao Han, MD, Assistant Professor, Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, No. 1588 Xincheng Road, Yixing 214200, Jiangsu Province, China. staff940@yxph.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Cerebral complications after unilateral biportal endoscopic surgery: A case report
Chao Han, Zhan-Yun Ren, Zhen-Huan Jiang, Yi-Feng Luo
Chao Han, Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
Zhan-Yun Ren, Department of Neurology, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
Zhen-Huan Jiang, Department of Orthopedics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
Yi-Feng Luo, Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
Co-corresponding authors: Chao Han and Yi-Feng Luo.
Author contributions: Jiang ZH, Ren ZY and Luo YF contributed to data collection and discussion; Han C contributed to drafting of the manuscript. All authors provided final approval for the submitted version.
Informed consent statement: The patient has given her consent for her clinical information to be used anonymously for the publication of her case study.
Conflict-of-interest statement: The authors declare there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chao Han, MD, Assistant Professor, Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, No. 1588 Xincheng Road, Yixing 214200, Jiangsu Province, China. staff940@yxph.com
Received: September 18, 2024 Revised: December 5, 2024 Accepted: December 27, 2024 Published online: May 6, 2025 Processing time: 114 Days and 22.7 Hours
Abstract
BACKGROUND
Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.
CASE SUMMARY
A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.
CONCLUSION
Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.
Core Tip: Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered as the principal reason of cerebral complications following UBE surgery. We herein presented a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus, accompanied by de-cerebrate rigidity. The case indicated that pneumocephalus induced by dural injury may also be a potential cause. Definitive diagnostic imaging is essential to discriminate the special condition.
