Nonconvulsive status epilepticus due to pneumocephalus after suprasellar arachnoid cyst fenestration with transsphenoidal surgery: illustrative case

BACKGROUND: Nonconvulsive status epilepticus (NCSE) requires prompt diagnosis and treatment, particularly after neurosurgical procedures for cerebral damage. Here, the authors reported an extremely rare case of suprasellar arachnoid cyst presenting with NCSE after cyst fenestration with transsphenoidal surgery, which was associated with pneumocephalus. OBSERVATIONS: A 61-year-old man presented with visual impairment and was diagnosed with a suprasellar arachnoid cyst on magnetic resonance imaging (MRI). The patient received cyst fenestration with endonasal transsphenoidal surgery. His visual symptoms improved immediately after the operation; however, on postoperative day 3, semicoma appeared and was prolonged. The patient was diagnosed with NCSE due to pneumocephalus based on MRI and electroencephalography (EEG) findings. The administration of antiepileptic drugs (AEDs) improved his clinical symptoms and the abnormal findings on MRI and EEG. LESSONS: This is the first case of NCSE with pneumocephalus after transsphenoidal surgery for a suprasellar arachnoid cyst. Pneumocephalus due to cerebrospinal fluid leakage can cause NCSE. Arterial spin labeling perfusion imaging and diffusion-weighted imaging are as useful for differentially diagnosing NCSE as EEG and AED tests.