J Korean Neurotraumatol Soc.  2009 Dec;5(2):106-108. 10.13004/jknts.2009.5.2.106.

Delayed Tension Pneumocephalus due to Rupture of the Pneumocyst

• Lee WC
• Seo DH
• Choe IS
• Park SC

• KMID: 1427368
• DOI: http://doi.org/10.13004/jknts.2009.5.2.106

Abstract

Tension pneumocephalus is an unusual delayed presentation of trauma. This case is presentation of a young man who suffered sudden deterioration of mental status from the rupture of the preexisting pneumocyst. He had a history of basal skull fracture, had a ventriculoperitoneal shunt placed due to posttraumatic hydrocephalus and had also undergone the repairing operation of basal skull defect at another hospital. The successful treatment of tension pneumocephalus and persistent pneumocyst at our hospital is described. The neurosurgeon must be aware the possibility of delayed pneumocyst formation and tension pneumocephalus in patients who experienced basal skull fracture quite a long time ago.

Keyword

Tension pneumocephalus; Pneumocyst; Basal skull fracture

MeSH Terms

Humans
Hydrocephalus
Pneumocephalus
Rupture
Skull
Skull Fractures
Ventriculoperitoneal Shunt

Figure

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  FIGURE 1 A CT scan showing a round air pocket on the right frontal lobe.

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  FIGURE 2 CT scans at emergent admission. Bilateral frontotemporal air collection and multiple air densities on the of the subdural space compressing brain parenchyma (A). The size of air pocket showing smaller than initial state (B).

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  FIGURE 3 A CT scan of the postoperative day 4 (1st operation) showing remained pneumocyst without change of size.

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  FIGURE 4 A coronal CT scan of postoperative day 14 (1st operation) still showed persistent pneumocyst connected with the fractured ethmoid sinus.

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  FIGURE 5 CT scans of postoperative 2 months (2nd operation) demonstrate complete resolution of pneumocyst (A) and good covering of fascia lata graft over the fractured ethmoid sinus (B).

Reference

1. Arbit E, Shah J, Bedford R, Carlon G. Tension pneumocephalus: treatment with controlled decompression via a closed water-seal drainage system. Case report. J Neurosurg. 1991; 74:139–142.

2. Cartwright MJ, Eisenberg MB. Tension pneumocephalus associated with rupture of a middle fossa encephalocele. Case report. J Neurosurg. 1992; 76:292–295.

3. Iplikcioglu AC, Bek S, Bikmaz K, Basocak K. Tension pneumocyst after transsphenoidal surgery for rathke's cleft cyst: case report. Neurosurgery. 2003; 52:960–962.

4. Cho HL, Han YM, Hong YK. Tension pneumocephalus after transsphenoidal surgery: report of two cases. J Korean Neurosurg Soc. 2004; 35:536–538.

5. Lunsford LD, Maroon JC, Sheptak PE, Albin MS. Subdural tension pneumocephalus. Report of two cases. J Neurosurg. 1979; 50:525–527.

6. McClay JE, Carreno O, Gupta A, Willner A. Treatment of Postcraniotomy Tension Pneumocephalus via Endoscopic Closure of the Nasofrontal Recess. Skull Base Surg. 1998; 8:221–224.

7. Michel SJ. The Mount Fuji sign. Radiology. 2004; 232:449–450.

8. Sasani M, Ozer FA, Oktenoglu T, Tokatli I, Sarioglu AC. Delayed and isolated intraventricular tension pneumocephalus after shunting for normal pressure hydrocephalus. Neurol India. 2007; 55:81–82.

9. Satapathy GC, Dash HH. Tension pneumocephalus after neurosurgery in the supine position. Br J Anaesth. 2000; 84:115–117.

10. Thompson TP, Levy E, Kanal E, Lunsford LD. Iatrogenic pneumocephalus secondary to intravenous catheterization. Case report. J Neurosurg. 1999; 91:878–880.