Highlights
- •Tension pneumocephalus is a neurosurgical emergency manifested by headaches, seizures, reduced consciousness and even death.
- •Tension pneumocephalus is a potential complication after skull base surgery.
- •A characteristic finding with tension pneumocephalus on imaging is the Mt. Fuji sign.
- •Accurate diagnosis requires appreciation of imaging features and a high index of suspicion.
- •Prompt intervention is imperative, and definitive management involves repair of the defect allowing intracranial air entry.
Abstract
Pneumocephalus describes the presence of air within the cranial cavity and is often
self-limiting. Tension pneumocephalus is a neurosurgical emergency manifested by headaches,
seizures, reduced consciousness and even death resulting from raised intracranial
pressure. Differentiating both entities clinically is often challenging but crucial.
We present a case involving a sixty-year-old male who was transferred to our unit
after he collapsed while undergoing rehabilitation. The patient had undergone a combined
bifrontal craniotomy and transnasal endoscopic resection of recurrent sinonasal adenocarcinoma
with anterior skull base involvement eight days prior. Imaging demonstrated the classic
Mt. Fuji sign and a diagnosis of tension pneumocephalus was formed. The patient proceeded
for definitive management which included a multi-layered repair of the anterior skull
base. The three mechanisms that propose the development of tension pneumocephalus
include the ball-valve mechanism, the inverted soda-bottle effect and rarely, infection
from gas forming organisms. A review of current literature on PubMed/MEDLINE revealed
tension pneumocephalus after skull base surgery to be a rare entity with only eleven
cases reported. Most patients achieved complete recovery of symptoms post-treatment.
Clinicians should recognise tension pneumocephalus as a potential complication after
skull base surgery. Accurate diagnosis requires appreciation of imaging features and
a high index of suspicion. Prompt management is imperative to prevent possible devastating
outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Handbook of neurosurgery.8th ed. Thieme, New York2016
- Subdural tension pneumocephalus following surgery for chronic subdural hematoma.J Neurosurg. 1988; 68: 58-61
- Tension pneumocephalus from skull base surgery: a case report and review of the literature.Surg Neurol Int. 2018; 9: 128
- Endoscopic repair of large skull base defects after powered sinus surgery.Otolaryngol Head Neck Surg. 2003; 129: 204-209
- Normobaric hyperoxia for treatment of pneumocephalus after posterior fossa surgery in the semisitting position: a prospective randomized controlled trial.PLoS One. 2015; 10e0125710
- Tension pneumocephalus after endoscopic sinus surgery.Ann Otol Rhinol Laryngol. 1994; 103: 235-237
- Focal intraparenchymal tension pneumocephalus.Neurology. 2006; 67: 1485
- Intraventricular tension pneumocephalus after transsphenoidal surgery: a case report and literature review.Neurocirugia (Astur). 2007; 18: 134-137
- Intracerebral tension pneumocephalus complicating endoscopic sinus surgery: case report.Acta Neurochir (Wien). 2009; 151: 1001-1002
- Tension pneumocephalus with diplegia and deterioration of consciousness.Case Rep Neurol. 2011; 3: 48-49
- Tension pneumocephalus: an extremely small defect leading to an extremely serious problem.Am J Otolaryngol. 2013; 34: 749-752
- Tension pneumocephalus: an uncommon cause of altered mental status.J Emerg Med. 2013; 44: 340-343
- Intraventricular tension pneumocephalus after endoscopic skull base surgery.J Neurol Surg A Cent Eur Neurosurg. 2013; 74: e96-e99
- Tension pneumocephalus causing brain herniation after endoscopic sinus surgery.Asian J Neurosurg. 2016; 11: 309-310
- Tension pneumocephalus: a rare complication of transsphenoidal resection of a pituitary macroadenoma.Cureus. 2019; 11e4623
Article info
Publication history
Published online: April 02, 2020
Accepted:
March 20,
2020
Received:
January 12,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
