Tension pneumocephalus – A rare complication of cerebrospinal fluid leak

Abstract

Three months following a craniectomy and cranioplasty indicated for intraperenchymal hemorrhage, a 74-year-old male suffered a cerebrospinal fluid leak complicated by delayed tension pneumocephalus and declining neurologic status demonstrating a particularly rare complication of neurologic trauma and surgery. While with symptoms of a space occupying mass is the most common presentation, the patient presented cerebrospinal fluid leak prompting CT imaging and diagnosis. Urgent surgical decompression is necessary and was performed resulting in improved mental status.

Application of the subdural evacuating port system for the drainage of postoperative tension pneumocephalus: A technical note

“…Although rarely under tension, pneumocephalus is a common occurrence after neurosurgical procedures. [ 2 , 16 ] There is no established treatment of pneumocephalus after skull base surgery in the literature; however, the association of pneumocephalus with a skull base defect is similar to that of postoperative CSF leaks and may benefit from similar management. [ 1 ] Most collections are small, benign, and respond to conservative therapy (i.e., bed rest and supplemental oxygen); however, space-occupying tension pneumocephalus requires prompt diagnosis and treatment.…”

“…The former suggests that positive pressure (e.g., sneezing, coughing, Valsalva maneuvers) pulls air intracranially through a cranial defect, and resists outflow leading to tension pneumocephalus. [ 2 , 10 , 16 ] The latter indicates that drainage of cerebrospinal fluid (CSF) leads to negative intracranial pressure (ICP) that is relieved by the influx of air through a cranial defect. [ 8 ] In cases of pneumocephalus, normobaric oxygenation reduces the volume of intracranial air through accelerated clearance of nitrogen.…”

Tension Pneumocephalus: A Rare Complication of Transsphenoidal Resection of a Pituitary Macroadenoma

“…It can be located in the epidural, subarachnoid, intraventricular, intracerebral, or subdural space, with the subdural space being the most frequent. When PNC causes intracranial hypertension and has a mass effect, it is called tension pneumocephalus (TP) [1]. This is a rare, but treatable, neurosurgical emergency.…”

“…Trauma is the most common cause of TP. Uncommon causes of TP include cranial or spinal surgeries as well as ear, nose, and throat (ENT) surgical procedures, such as paranasal sinus surgery, nasal septum resection, or nasal polypectomy [1][2]. Clinically, TP can present as restlessness, altered mentation, focal neurological deficits, or sometimes even cardiac arrest.…”

“…The computed tomography (CT) head performed showed the Mount Fuji sign due to mass effect on brain parenchyma by intracranial air. 1 1 2…”