Endoscopic sinus surgery (ESS) may rarely be complicated by intracranial complications; the most common of them is a cerebrospinal fluid fistula. Pneumocephalus as a complication of ESS is quite rare. Here, we presented a unique case of tension pneumocephalus causing brain herniation as a complication of ESS, to whom emergent craniotomy was performed.

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This study was designed to determine the incidence of complications occurring after a decompressive craniectomy (DC) without duraplasty. Methods:The data of 42 consecutive patients who underwent DC without watertight duraplasty were evaluated retrospectively and analyzed. Results:The average age of the study group patients was 62.7 years (range: 34-90 years) and 32 of the 42 patients of them were male. The mean Glasgow Coma Scale (GCS) score was 7, the mean midline shift was 12.1 mm, and the mean length of time from injury until DC was 1.9 days. Twenty-three patients were alive at least 20 days after DC. Antibiotherapy was used to treat a wound infection in 3 (7.1%) patients. Two of these 3 patients were male and the mean age was 65.3 years. The mean GCS score before surgery in this subset of complicated cases was 7, the mean midline shift was 15 mm, and the mean length of time until DC was 3.3 days. No other complications, such as brain abscess, meningitis, cerebrospinal fluid (CSF) fistula, or wound healing abnormalities were observed. Conclusion:DC without watertight duraplasty had an acceptable incidence of postoperative complications. This technique reduces the surgical time of surgery, which can be vital in critical patients with malignant middle cerebral artery infarction or intracerebral hematoma.