- •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.
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.
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Published online: April 02, 2020
Accepted: March 20, 2020
Received: January 12, 2020
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