Hyperbaric Oxygen Therapy in Postoperative Intracranial Pneumocephalus After Lumbar Decompression: A Case Study.

Intracranial pneumocephalus is an extremely rare complication following posterior lumbar surgery. We present a case of a 67-year-old female who underwent posterior lumbar interbody fusion (PLIF) at L4/5 for lumbar disc herniation. During the procedure, severe adhesions between the ligamentum flavum and dura mater were encountered, resulting in an inadvertent dural tear with cerebrospinal fluid (CSF) leakage. Six hours postoperatively, the patient abruptly developed dysarthria, expressive aphasia, and right-sided hemiparesis. Emergency cranial computed tomography revealed pneumocephalus predominantly in the bilateral frontotemporal sulci and suprasellar cistern, with greater involvement on the right side. Conservative management, including strict bed rest, intravenous hydration, analgesia, and hyperbaric oxygen therapy (HBOT), was initiated, leading to gradual neurological recovery. This case highlights the clinical presentation, management, and outcomes of this rare complication, with emphasis on the potential role of HBOT in treatment.