Postmastoidectomy Pneumocephalus: Case Report

Abstract

Chronic otitis media, unlike trauma, seldom leads to the development of tension pneumocephalus. Rarely, it occurs as a complication of mastoid surgery. A Melanesian woman sought treatment for loss of speech, hemiparesis, and headache 4 weeks after undergoing canal-down mastoidectomy for cholesteatoma. The tension pneumocephalus was decompressed urgently by aspirating air via a cannula through the burr hole, and the mastoid cavity was obliterated. She recovered completely. Twelve additional patients with postmastoidectomy pneumocephalus reported in the literature are reviewed.

Extensive pneumocephalus extending into the lateral ventricles from a brain abscess: an intracranial complication of cholesteatoma

“…6 There are two types of Valsalva manoeuvre: (1) 'nose-pinched' Valsalva, whereby forceful exhalation is attempted against pinched nostrils, and (2) 'glottic' Valsalva, whereby positive pressure is applied against a closed glottis. 6 There are two types of Valsalva manoeuvre: (1) 'nose-pinched' Valsalva, whereby forceful exhalation is attempted against pinched nostrils, and (2) 'glottic' Valsalva, whereby positive pressure is applied against a closed glottis.…”

“…Pneumocephalus development is considered to occur via two principle mechanisms – nose-blowing and Valsalva manoeuvre – both of which cause intermittent episodes of increased pressure within the middle ear 6 . There are two types of Valsalva manoeuvre: (1) ‘nose-pinched’ Valsalva, whereby forceful exhalation is attempted against pinched nostrils, and (2) ‘glottic’ Valsalva, whereby positive pressure is applied against a closed glottis.…”

Minimally Invasive Transcanal Endoscopic Ear Surgery

“…Although mastoidectomy is a procedure that is familiar to all otosurgeons, it can be complicated by accidental trauma to middle cranial fossa dura, dural exposure in the tegmen and sinodural angle, and brain herniation into the mastoid cavity. Dural and tegmen defect due to dural tears and cerebrospinal fluid leakage may result in pneumocephalus, brain herniation, subdural empyema, epidural or brain abscess [33][34][35][36][37][38][39]. In addition to primary cholesteatoma cases, minimally invasive TEA can be applied for revision of canal-wall-up (CWU) cases, when residual/recurrent cholesteatoma is confined to the middle ear, and in CWD or radical cavities, when residual/recurrent disease is hidden in the supratubal recess, sinus tympani or under pseudo-membrane in the large mastoid cavities, when access to cholesteatoma via external ear canal is difficult using the operating microscope due to the limited axis of work [24].…”