A Rare Case of Temporal Bone Pneumocephalus Tracking through the Internal Auditory Canal

Watson, WayAnne; Mulry, Erin; Kaufman, A; Eliades, Steven J.

doi:10.1159/000510672

Cited by 1 publication

(1 citation statement)

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“…Most importantly, patients with pneumoventricle or pneumocephalus in the absence of trauma or other iatrogenic intervention must have a thorough and complete workup, including magnetic resonance imaging of the entire neural axis. As air can enter the intrathecal space from otherwise unknown sinus or tegmen defects, it is also important to obtain fine-cut CT scans of the skull base ( 11 , 12 ). Patients with previous history of anterior abdominal surgery and anterior spinal surgery should undergo consideration of CT abdomen and pelvis with oral contrast to assess for fistulous connections to the intrathecal space, especially if such a connection is suggested by the previously obtained MRIs.…”

Section: Discussionmentioning

confidence: 99%

Enterothecal fistula as a rare cause of adult pneumocephalus and meningitis: a case report

Wang¹,

Tabarestani²,

Mehta³

et al. 2023

J Spine Surg

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Background Enterothecal fistulas are pathological connections between the gastrointestinal system and subarachnoid space. These rare fistulas occur mostly in pediatric patients with sacral developmental anomalies. They have yet to be characterized in an adult born without congenital developmental anomaly yet must remain on the differential diagnosis when all other causes of meningitis and pneumocephalus have been ruled out. Good outcomes rely on aggressive multidisciplinary medical and surgical care, which are reviewed in this manuscript. Case Description A 25-year-old female with history of a sacral giant cell tumor resected via anterior transperitoneal approach followed by posterior L4-pelvis fusion presented with headaches and altered mental status. Imaging revealed that a portion of small bowel had migrated into her resection cavity and created an enterothecal fistula resulting in fecalith within the subarachnoid space and florid meningitis. The patient underwent a small bowel resection for fistula obliteration, and subsequently developed hydrocephalus requiring shunt placement and two suboccipital craniectomies for foramen magnum crowding. Ultimately, her wounds became infected requiring washouts and instrumentation removal. Despite a prolonged hospital course, she made significant recovery and at 10-month following presentation, she is awake, oriented, and able to participate in activities of daily living. Conclusions This is the first case of meningitis secondary to enterothecal fistula in a patient without a previous congenital sacral anomaly. Operative intervention for fistula obliteration is the primary treatment and should be performed at a tertiary hospital with multidisciplinary capabilities. If recognized quickly and appropriately treated, there is a possibility of good neurological outcome.

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Section: Discussionmentioning

confidence: 99%