Intraventricular Tension Pneumocephalus Research Articles

Spontaneous Intraventricular Tension Pneumocephalus

Here, we report a very rare case of spontaneous intraventricular tension pneumocephalus. This case concerns a 40-year-old patient with medical history of a tumor of the pineal region and a secondary hydrocephalus treated by multiple ventriculoperitoneal shunts. He presented in the emergency room because of unusual headaches, nausea, and visual loss. In addition, he reported slight rhinorrhea in the past few weeks. The initial brain computed tomography scan revealed a spontaneous intraventricular tension pneumocephalus. There was no history of recent head trauma and no sign of disconnection of the shunt system. A complementary radiologic assessment including a thin-slice bone computed tomography scan and a radioisotope cisternography revealed an osseous defect and an isotope leakage at the junction between the tegmen tympani and the squamous part of the left temporal bone. A middle cranial fossa surgery was performed to repair the osteo-meningeal breach.

MRI diagnosis of spontaneous intraventricular tension-pneumocephalus in a 10-month-old male Saarloos Wolfdog.

A 10-month-old male Saarloos Wolfdog was presented with a history of multiple neurologic deficits that had acutely progressed. Neurologic examination findings localized signs to the cerebrum and brainstem. Magnetic resonance imaging revealed markedly enlarged and gas-filled lateral ventricles with a mass effect leading to cerebellar herniation. A right-sided defect of the cribriform plate with a dysplastic ethmoturbinate was identified as the inlet of air and origin of the intraventricular tension pneumocephalus. Surgical findings were consistent with a ruptured, congenital, nasal meningocele.

Intraventricular Tension Pneumocephalus After Subarachnoid Hemorrhage and Removal of an External Ventricular Drain

Pneumocephalus is defined as an accumulation of air or gas in the intracranial space. It is a common complication after skull surgery or craniofacial trauma, sometimes also caused by gas-producing organisms in the context of an infection, and reported with cerebrospinal fluid draining procedures. Here we report a case of a large intraventricular tension pneumocephalus after removal of an external ventricular drain in a patient with subarachnoid hemorrhage. The acute management included therapy with normobaric oxygen. Despite the large volume of trapped air and its diffuse distribution inside the skull and spine, therapy with 100% normobaric oxygen appears to be safe and efficient for a rapid improvement of the patient's symptoms and the neuroradiological imaging.

Intraventricular Tension Pneumocephalus and Pneumorrhachis in a Dog; Diagnosis, Treatment, and MRI Follow-Up

Intraventricular Tension Pneumocephalus and Pneumorrhachis in a Dog; Diagnosis, Treatment, and MRI Follow-Up

Intraventricular Tension Pneumocephalus after Endoscopic Skull Base Surgery

Postoperative pneumocephalus is commonly observed after neurosurgical intracranial procedures and is usually of little consequence. Intraventricular tension pneumocephalus, however, is a rare complication and a neurosurgical emergency that requires immediate intervention. We describe the first case of intraventricular tension pneumocephalus that developed 1 week following an expanded endoscopic endonasal approach for resection of a suprasellar mass. A patient who underwent an endoscopic transplanum transtuberculum approach for resection of a suprasellar epidermoid tumor developed a sudden change in mental status, with imaging consistent with intraventricular tension pneumocephalus. Immediate endotracheal intubation and placement of an external ventricular drain prevented further deterioration. Endoscopic exploration of the skull base reconstruction revealed a one-way ball valve mechanism as the source of pneumocephalus. The skull base reconstruction was revised with autologous fascia lata and repositioning of the pedicled nasoseptal flap. Intraventricular tension pneumocephalus is a rare neurosurgical emergency that may develop after endoscopic skull base surgery. Initial management includes endotracheal intubation and placement of an external ventricular drain to decompress the ventricles. Endoscopic exploration and revision of the skull base repair is imperative to obliterate the ball-valve fistula to prevent further entrapment of air.

Akinetic Mutism and Parkinsonism due to Subdural and Intraventricular Tension Pneumocephalus

Pneumocephalus may occur after intracranial surgery and is most often asymptomatic. It is usually associated with posterior fossa surgery. Here, we present a 56-year-old man who developed akinetic mutism and parkinsonism caused by subdural and intraventricular tension pneumocephalus associated with decompression of a chronic subdural hygroma. As an emergency treatment, air was exchanged with saline via the drainage, which then was removed and a subduro-peritoneal shunt was implanted. The condition described here requires immediate attention and appropriate treatment.

Temporal Lobe Encephalocele in the Lateral Recess of the Sphenoid Sinus Presenting with Intraventricular Tension Pneumocephalus

A basal encephalocele often shows an insidious clinical course. Only two cases of temporal lobe encephalocele accompanied with tension pneumocephalus have previously been reported. In this paper, we describe a case of lateral sphenoid sinus encephalocele presenting with intraventricular tension pneumocephalus. A 54-year-old man was referred to our institution presenting with intraventricular tension pneumocephalus. He had undergone ventriculoperitoneal shunt placement for postmeningitis hydrocephalus 3 months before this admission. Precise imaging examinations detected evidence suggestive of a lateral sphenoidal sinus recess encephalocele. Endoscopic transnasal approach was performed for surgical repair of the encephalocele. The encephalocele was removed with subsequent repair of the bony defect. Histological examination showed that the encephalocele includes a part of the ventricular system. This indicates that air might enter directly into the ventricular system after rupture of the temporal lobe encephalocele. A lateral sphenoid sinus encephalocele would potentially cause intraventricular tension pneumocephalus, although pneumocephalus is an extremely unusual complication of this type of basal encephaloceles.

Intraventricular tension pneumocephalus secondary to head trauma in a horse

Intraventricular tension pneumocephalus secondary to head trauma in a horse

Intraventricular tension pneumocephalus and cervical subarachnoid pneumorrhachis in a bull mastiff dog after craniotomy

An eight-year-old bull mastiff dog underwent a craniotomy for surgical excision of an olfactory lobe meningioma. Rapidly progressive neurological deficits with cervical pain developed within the early postoperative period. Intraventricular and cervical subarachnoid space air accumulation (pneumorrhachis) was identified through magnetic resonance imaging and computed tomography. Repair of a dural defect using synthetic dura substitute resulted in gradual resolution of neurological signs attributable to the tension pneumocephalus and subarachnoid space pneumorrhachis. Regrowth of the meningioma was not observed. Postoperative intraventricular tension pneumocephalus and air accumulation within subarachnoid space are uncommon but life-threatening complications of intracranial surgery. Early diagnosis and treatment can result in a satisfactory outcome.

Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: presentación de un caso y revisión de la literatura

Tension pneumocephalus is a rare complication of transsphenoidal approaches. The case of a 37 year old woman with a transsphenoidal resection of a pituitary adenoma who presented self-limited rhinoliquorrhea postoperatively is reported. Three days later the patient developed progressive decreased consciousness, amnesia and headache, showing an intraventricular tension pneumocephalus on CT scan. Urgent treatment with bilateral external ventricular drainage and anterior nasal tamponade was performed with good clinical outcome. Later transsphenoidal sealing of the dural defect was achieved without recurrence. Tension pneumocephalus following transsphenoidal surgery usually occurs after the presentation of a cerebrospinal fluid leak due to an incomplete sealing of the sphenoid sinus. The postoperative insertion of a lumbar drainage seems to be a predisposing condition for this complication. The combined approach of tension pneumocephalus with external ventricular drainage and repair of the sphenoid sinus offers optimal results solving the acute neurological deterioration and avoiding recurrence.

Delayed and isolated intraventricular tension pneumocephalus after shunting for normal pressure hydrocephalus

Delayed and isolated intraventricular tension pneumocephalus after shunting for normal pressure hydrocephalus

Recurrent spontaneous pneumocephalus in a shunted patient

Nine years prior to admission a 33 year old female had suffered a left-sided skull fracture without pyramidal involvement. In the same year she underwent a radical ear operation on the left due to chronic otitis media. Four years later, gradual signs of raised intracranial pressure developed and a communicating hydrocephalus was confirmed by cine-MRT. After ventriculoperitoneal shunt placement the patient underwent two laparotomies because of intra-abdominal pseudocyst formation and laparoscopic ovarian cystectomy. Five years after shunt implantation, sudden confusion, uncooperativeness, incontinence and paraparesis of lower limbs occurred. Cranial CT showed extended subdural tension pneumocephalus with collapsed brain (Fig. 1a). Isotope cisternography confirmed right frontobasal fistula, and duroplasty was performed. Air was absorbed gradually and the patient became symptom-free within three weeks. One month after discharge from hospital the patient felt popping in the left ear. Serious headache, gait disturbance, neck stiffness and paraparesis developed quickly again. CT revealed intraventricular tension pneumocephalus (Fig. 1b). After gradual improvement, repeated cisternography confirmed a CSF leak through the left middle ear. Transmeatal repair and intracranial duroplasty were carried out. The patient left ambulatory and has remained complaint-free for five years. The originally inserted shunt has remained in situ. Rare cases of spontaneous pneumocephalus in the literature can be found in shunted patients [3]. The mechanism of air accumulation is connected with long-standing raise of ICP and consecutive erosion of the skull base [1, 4] resulting in a ‘‘ball valve effect’’ or an ‘‘inverted

Intraventricular tension pneumocephalus as a complication of paranasal sinus surgery

Intraventricular tension pneumocephalus as a complication of paranasal sinus surgery

Intraventricular Tension Pneumocephalus as a Complication of Paranasal Sinus Surgery

Abstract A case of intraventricular tension pneumocephalus occurring as a complication of paranasal sinus surgery is presented. The pathophysiology of tension pneumocephalus is discussed and emphasis is placed on the potentially life-threatening increase in intracranial pressure that occurs. Tension pneumocephalus requires prompt diagnosis and treatment.