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

Affiliations
  • 1Department of Neurosurgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea. psc710@kwandong.ac.kr

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

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

  • 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).

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

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

  • 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).


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