Delayed onset of intracerebral tension pneumocephalus 2 years after an anterior skull base fracture: Case report
Sokchan Sim1, Yoshifumi Okada2
1Country Director, Jeremiah’s Hope Center, Phnom Penh, Cambodia
2Department of Neurosurgery, Kitahara International Hospital, Tokyo, Japan
*Sokchan Sim, MD, IFAANS, Country Director, Jeremiah’s Hope Center, Phnom Penh, Cambodia.
Figure 1: A. Axial view of the CT scan showing hypodensity area in the left frontal lobe, pneumocephalus. B. Sagittal view presenting the large air space with its connection to the frontal skull base. C. Coronal view showing the bony defect of the anterior skull base.
We decided to perform the surgery by doing bi-coronal approach for a left frontal craniotomy and repair of the dura defect on the frontal skull base using the pedunculated galea flap. (Figure.2)
Figure 2 :A. Bi-coronal incision with preservation of large frontal galea. B. Galea still attached to the frontal base is lifted up.
The surgery went well without any complication. The post-operative course was without any significant event. No sign of infection was noticed. The patient recovered gradually from his motor deficit on his right side. The post-operative CT scan showed complete resorption of the intracerebral pneumocephalus. (Figure.3). Intravenous prophylactic antibiotics were used to prevent meningitis.
Figure 3: Post-operative CT scan showing no hypodensity area in the left frontal lobe, complete disappearance of the pneumocephalus A. Axial view B. Sagittal view C. Coronal view. Noted the small bone defect from craniotomy site.
At one-month follow-up, his motor function on the right body became normal that he could play his favorite guitar again. At three-month follow up, he had an episode of new seizures, we controlled his seizures with anti-epileptic drugs for two years afterward.
- Kankane VK, Jaiswal G, Gupta TK. Posttraumatic delayed tension pneumocephalus: Rare case with review of literature. Asian J Neurosurg. 2016 Oct-Dec;11(4):343-347.
- JELSMA F, MOORE DF. Cranial aerocele. Am J Surg. 1954 Mar;87(3):437-51.
- Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit Care. 2010 Aug;13(1):152-8.
- Kon T, Hondo H, Kohno M, Kasahara K. Severe tension pneumocephalus caused by opening of the frontal sinus by head injury 7 years after initial craniotomy – Case report. Neurol Med Chir (Tokyo) 2003; 43:242–5.
- Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery PR, 2nd, Papadimos TJ, et al. Traumatic tension pneumocephalus: Two cases and comprehensive review of literature. OPUS 12 Sci. 2010;4:6–11.
- Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery PR, Papadimos TJ, Stawicki SP. Traumatic tension pneumocephalus - Two cases and comprehensive review of literature. Int J Crit Illn Inj Sci. 2017 Jan-Mar;7(1):58-64
- Lunsford LD, Maroon JC, Sheptak PE, Albin MS. Subdural tension pneumocephalus. Report of two cases. J Neurosurg. 1979; 50:525–7.
- 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; 74:139–42.