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Skull base surgery. 1998; 8(4): 221–224.
PMCID: PMC1656710

Treatment of Postcraniotomy Tension Pneumocephalus via Endoscopic Closure of the Nasofrontal Recess

Abstract

Tension pneumocephalus can be a life-threatening complication following cranial surgery. We report a 14-year-old female who developed tension pneumocephalus following her most recent external approach to a recurrent pilocytic astrocytoma of the skull base and clivus. Because the risk of devascularization of the recently placed bone grafts was a concern, an endoscopic approach was chosen instead of a cramotomy. Endoseopic decompression was accomplished by opening the anterior ethmoid and frontal recess air cells after performing an uncinectomy. The nasofrontal recess areas were then packed from below with grafts of muscle and fascia lata. Follow-up magnetic resonance imaging (MRI) at three and eight months showed complete resolution of the intracranial air. At two-year follow-up, the patient is still asymptomatic. This case report presents treatment of tension pneumocephalus through endoscopic decompression and closure of the nasofrontal recess as a viable option if significant risks are associated with craniotomy and the status of the mucosa of the nasal frontal recess is known.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Reasoner DK, Todd MM, Scamman FL, Warner DS. The incidence of pneumocephalus after supratentorial craniotomy. Observations on the disappearance of intracranial air. Anesthesiology. 1994 May;80(5):1008–1012. [PubMed]
  • Richtsmeier WJ, Briggs RJ, Koch WM, Eisele DW, Loury MC, Price JC, Mattox DE, Carson BS. Complications and early outcome of anterior craniofacial resection. Arch Otolaryngol Head Neck Surg. 1992 Sep;118(9):913–917. [PubMed]
  • Sekerci Z, Akalan N, Kiliç C, Demirkazik M. Pneumocephalus at the cerebellopontine angle secondary to chronic otitis media. Clin Neurol Neurosurg. 1990;92(2):155–157. [PubMed]
  • Matsuba HM, Thawley SE, Smith PG. Tension pneumocephalus: a case following otologic surgery. Am J Otol. 1986 May;7(3):208–209. [PubMed]
  • Wormald PJ, McDonogh M. 'Bath-plug' technique for the endoscopic management of cerebrospinal fluid leaks. J Laryngol Otol. 1997 Nov;111(11):1042–1046. [PubMed]
  • Wax MK, Ramadan HH, Ortiz O, Wetmore SJ. Contemporary management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 1997 Apr;116(4):442–449. [PubMed]
  • Hughes RG, Jones NS, Robertson IJ. The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience. J Laryngol Otol. 1997 Feb;111(2):125–128. [PubMed]
  • Casiano RR, Cooper J. Anterior table free bone graft technique for frontal sinus obliteration. Otolaryngol Head Neck Surg. 1992 Apr;106(4):363–366. [PubMed]

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