Severe Tension Pneumocephalus Complicating Frontal Sinus Osteoma

Abstract

Background: Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion. Case Report: We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma. Despite prompt decompression and repair of the fistulous connection between the sinus and the intracranial compartment, the patient suffered permanent frontal lobe damage with significant neurocognitive sequelae and seizures. Conclusions: This case illustrates that tension pneumocephalus can be a dangerous entity with potential for early mortality and long-term morbidity. We recommend, therefore, early treatment and close follow up of destructive lesions involving the posterior frontal sinus wall. RESUME: Pneumo-encephale severe compliquant un osteome du sinus frontal: a propos d'un cas. Introduction: Le pneumo-encephale sous tension, une accumulation de gazes sous pression, est une palhologie rare mais potentiellement mortelle qui peut compliquer une chirurgie craniofaciale, un traumatisme ou une tumeur cranienne. II se pr&ente comme une ldsion expansive aigue ou subaigue. Histoire de cas: Nous presentons le cas d'un homme de 40 ans qui a developpe un pneumo-encephale sous tension a la suite d'un ostdome du sinus frontal deja connu mais non traite\ Malgre une decompression rapide et une reparation de la fistule entre le sinus et le compartiment intracranien, le patient a subi un dommage permanent au lobe frontal avec des sequelles neurocognitives importantes et des crises d'epilepsie. Conclusion: Ce cas illustre que le pneumo-encfiphale sous tension puet etre une condition dangereuse avec un potentiel de mortalite precoce et de morbidity a long terme. Nous recommandons done un traitement prficoce et un suivi serre des lesions destructrices impliquant la paroi postfirieure du sinus frontal.Can. J. Neurol. Sci. 1998; 25: 79-81 Pneumocephalus is defined as an intracranial collection of gas in subdural, subarachnoid, intraventricular, extradural or intracerebral compartments. Tension pneumocephalus, or the accumulation of intracranial gas under pressure, has numerous etiologies, and can present with neurologic symptoms that mimic other more common space-occupying lesions. We describe a patient who presented with symptoms related to tension pneumocephalus secondary to an osteoma of the frontalethmoid sinus. We discuss the implications for sinus osteoma management and emphasize the potential for long-term morbidity from this life-threatening complication. CASE PRESENTATIONA 40-year-old male was incidentally found to have a right ethmoid sinus tumor, felt to most likely represent an osteoma. He refused surgical intervention. Approximately ten years later, he presented to the Emergency Department with a four day history of bifrontal headache, confusion and behaviour changes. ...

Imaging Diagnosis—trauma‐induced Tension Pneumocephalus

“…As more air accumulates, the increased intracranial pressure will lead to clinical neuropathy. The transformation of pneumocephalus into tension pneumocephalus rarely occurs 2,4,5 …”

“…Treatment of pneumocephalus in humans depends on the cause, severity of clinical signs, and degree of tension. If tension pneumocephalus is suspected, it is considered to be a surgical emergency due to progressive increase in intracranial pressure leading to brain hypoxia, cerebral infarction, and potential for cerebral or brainstem herniation 2,5 . Thus far, the treatment choice in dogs has been to repair the dural defect 6,9,10 .…”

Intraventricular Tension Pneumocephalus as a Complication of Transfrontal Craniectomy: A Case Report

“…Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life‐threatening condition reported in persons after surgery 1 . It may be classified according to its location as epidural, subdural, subarachnoid, intracerebral, or intraventricular, the latter being the most common site.…”

Pneumocephalus: Case Illustrations and Review

“…Putatively, these air bubbles enter the subarachnoid space through a tear in the arachnoid membrane caused by increased tension of air in the subdural space. These two CT findings are helpful in [5][6][7][8] Transsphenoidal or endoscopic sinus surgery [9] Shunt insertion [10,11] Twist-drill drainage of chronic subdural hematomas [12,13] Post-traumatic Fracture through air sinus or skull base Open fracture though cranial convexity with dural laceration Congenital skull or tegmen tympani defects [14] Neoplasms causing tumor erosion through the skull or skull base Osteomas, Epidermoid, Pituitary tumors [15][16][17][18] Infection with gas-producing organisms [19,20] Post invasive procedures Lumbar puncture [21] Ventriculostomy Spinal anesthesia [22] Barotrauma [23,24] making a diagnosis of subdural tension pneumocephalus following surgery for chronic subdural hematoma [12,13].…”

“…Evaluation and management should include consideration of infection in the setting of trauma and follow the principles for postsurgical pneumocephalus [14]. Osteomas [15][16][17], epidermoid [18], and pituitary tumors are examples of neoplasms that can cause erosion through the skull base or skull. Infection with gas-producing organisms can generate intracranial air collections.…”