Central nervous system air pressure: A tension dilemma

Abstract

Introduction: Tension pneumocephalus may lead to an increase in intracranial pressure and rapid neurologic deterioration and death. Therefore, this condition should be approached as a neurosurgical emergency.Case Report: A 34-year-old male was admitted for resection of a relapsed meningioma. At the time, the patient complained of bilateral visual loss and intense headaches. A transsphenoidal approach was performed and the tumor's left portion was completely resected. The tumor's right portion was adhered to the ipsilateral carotid artery and optic nerve structures. Its complete removal was unachievable. In the next days, he experienced multiple complications such as worsening amaurosis, vascular thrombosis, and a tension pneumocephalus was diagnosed on a computed tomography (CT) scan after physical exam showed signs of elevated intracranial pressure. He underwent an urgent external ventricular derivation and, the next days, multiple interventions were deemed necessary due to a recrudescent pneumocephalus