Spontaneous Otogenic Pneumocephalus Research Articles

Spontaneous Otogenic Pneumocephalus Triggered by Air Travel

Spontaneous Otogenic Pneumocephalus Triggered by Air Travel

Spontaneous Otogenic Intracranial Pneumocephalus: A Case Report.

Spontaneous otogenic pneumocephalus (SOP) is a rare condition. We report a case of SOP that may be related to repeated Valsalva maneuvers. A young woman underwent repeated Valsalva maneuvers to restore Eustachian tube function and subsequently developed symptoms that included otalgia, headache, and nausea. A temporal bone computed tomography scan was performed and a diagnosis of SOP was made. Subsequent surgical treatment was performed and no recurrence was found during the 1-year follow-up period. The rarity of SOP and its potential for misdiagnosis pose significant challenges in clinical practice. The Valsalva maneuver is 1 of the contributing factors to this phenomenon. Otologists should be familiar with the potential complications of the Valsalva maneuver and use it with greater caution.

A rare case of spontaneous otogenic pneumocephalus with pictorial illustration of temporal evolution

Pneumocephalus is commonly seen on imaging in the setting of craniofacial trauma, skull base tumours, intracranial infection and after neurological intervention. Spontaneous pneumocephalus in the absence of these conditions is exceedingly rare, with only approximately 30 cases reported in the literature to date. Spontaneous otogenic pneumocephalus (SOP) is believed to occur as a result of anomalous communication between the intracranial space and a hyper-pneumatised temporal bone, with either positive extra-to-intracranial pressure or negative intracranial pressure gradient. These anomalous communicating channels may only become clinically apparent when triggered by episodes of acute increase in middle ear pressure during coughing, sneezing, Valsalva manoeuvre or significant change in atmospheric pressure. Patients may exhibit a wide range of neurological symptoms and the aim of treatment is to reduce the risk of complications such as infection and intracranial hypertension. Both conservative and neurosurgical approaches have been described. We report a case of SOP in which the patient was conservatively managed, and spontaneous resolution of pneumocephalus was documented on serial computed tomography (CT) scans. This unique case clearly demonstrates the natural history and temporal evolution of SOP without surgical intervention. This knowledge may potentially obviate the need for surgery, thus reducing morbidity and mortality in patients who are poor surgical candidates.

Spontaneous Otogenic Pneumocephalus: Case Series and Update on Management.

Objectives This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation, and treatment. Design Four patients underwent a middle cranial fossa approach for repair of the tegmen tympani and tegmen mastoideum. A comprehensive review of the literature regarding this disease entity was performed. Setting U.S. tertiary academic medical center. Participants: Patients presenting to the lead author's clinic or to the emergency department with radiographic evidence of SOP. Symptoms included headache, otalgia, and neurologic deficits. Main Outcome Measures Patients were assessed for length of stay, postoperative length of stay, and neurologic outcome. Three of four patients returned to their neurologic baseline following repair. Results Four patients were successfully managed via a middle cranial fossa approach to repairing the tegmen mastoideum. Conclusion The middle cranial fossa approach is an effective strategy to repair defects of the tegmen mastoideum. SOP remains a clinically rare disease, with little published information on its diagnosis and treatment.

Spontaneous otogenic pneumocephalus presenting with occipital subcutaneous emphysema as primary symptom: could tension gas cause the destruction of cranial bones?

The authors report, to the best of their knowledge, the first case of a spontaneous tension pneumocephalus with subcutaneous emphysema. Hyperpneumatization of the cranium and mechanical compression contributed jointly to the formation of a fistula, and air pressure caused a subsequent disruption of the suture and air leakage into the subcutaneous space. A minimally invasive otological procedure proved efficacious for resolution.

Coma caused by spontaneous otogenic pneumocephalus

We present the first case of spontaneous otogenic pneumocephalus presenting with a rapid deterioration in conscious level. This occurred in a 69-year-old woman who was subsequently treated with a subtemporal, extradural exploration and packing of the multiple defects in the mastoid air cells. The patient made a full neurological recovery within 10 weeks. Spontaneous otogenic pneumocephalus is a rare condition and was previously understood to present with subtle symptoms of headache, aphasia and cognitive deficits. This case, however, establishes how it can cause a rapid decline towards coma.

Spontaneous otogenic pneumocephalus managed with the middle fossa approach

Objectives: Otogenic pneumocephalus is an uncommon entity usually caused by otologic surgery, trauma, tumor, or infection. Spontaneous pneumocephalus caused by barotrauma is extremely rare. We surveyed the literature and describe a case report of otogenic pneumocephalus from barotrauma managed with a middle fossa craniotomy. Methods: A literature review was performed by querying MEDLINE from 1966 to the present by querying the MeSH heading “Pneumocephalus” and filtering the results for cases involving the ear or mastoid. Case report: A 60-year-old man had onset of hearing loss, aural fullness with a “gurgling” sensation, and roaring tinnitus in the right ear following a transatlantic flight. Symptoms persisted for 3 months. The patient underwent CT and MRI scanning, which revealed air in the ventricular system, a right temporal lobe cyst, and a thinned tegmen. A clear middle ear effusion, air-bone gap of 30 dB, and a left superior homonymous quadrantanopsia were present. The patient underwent an exploratory middle fossa craniotomy. Results: At surgery, the middle fossa floor demonstrated multiple bony defects and there were several small holes in the dura. A multilayered repair of this area was undertaken using temporalis fascia, bone chips, synthetic dura, and fibrin glue. The literature review revealed 3 similar cases in the neurotologic literature. Conclusion: Spontaneous otogenic pneumocephalus remains an uncommon finding. Anatomic defects in the floor of the middle cranial fossa contribute to the development of this rare entity. Neurotologic consultation should be obtained. In selected instances, middle fossa craniotomy and repair of the dural and bony defects may be required.