Pneumoencephalography

Last revised by Daniel J Bell on 18 May 2022

Pneumoencephalography is an obsolete imaging technique that allowed evaluation of the contours of the brain and ventricles by the deliberate introduction of air into the subarachnoid space.

This was achieved initially by a needle passed directly into the ventricles (via the fontanelles or a burr hole). Small amounts of CSF were withdrawn and replaced with room air. The process was repeated over and over until no more CSF could be obtained 1,2

Later, it was realized that air inserted into the lumbar theca (via puncture) could be maneuvered into the desired subarachnoid spaces by careful position and tilting of the head. 

In the 1950s and 60s, as air was often to be found rather lacking as a negative contrast agent, there was a switch to using positive agents, known as contrast encephalography. Iofendylate (Pantopaque/Myodil), a contrast agent similar to Lipiodol, was a popular choice 4

Complications

Pneumoencephalography was said to be an extremely unpleasant undertaking for patients who commonly experienced severe headaches, nausea, diaphoresis, lassitude, and hypotension 4.

Early mortality rates of pneumoencephalography, quoted in one source as 1-3% were high, considering it was a diagnostic, and not a therapeutic technique 4

History and etymology

The procedure was developed by Walter E Dandy (1886–1946) an American pediatric neurosurgeon who practised at Johns Hopkins Hospital in Baltimore, Maryland in the United States 3

Pneumoencephalography rapidly became obsolete as CT entered clinical practice in the mid 1970s 4.

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: sulci outlined by air
    Drag here to reorder.
  • Case 2: ventricles outlined by air
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.