Tension pneumocephalus

Abstract

Tension pneumocephalus is a rare but treatable neurosurgical emergency. Prompt and accurate diagnosis of tension pneumocephalus requires a high index of clinical suspicion corroborated by imaging. Herein, we describe a case of extensive tension pneumocephalus in a patient who had undergone transsphenoidal surgery and repair of the sellar floor, with subsequent successful decompression. This case report discusses the pertinent imaging features of tension pneumocephalus and its management.

Fig. 1

Unenhanced axial CT image through the pons (in soft tissue window) shows expected minimal free air within the sellar region and bilateral temporal horns. No subarachnoid air is visible.

Fig. 2

Unenhanced axial CT image through the lateral ventricles shows a large amount of free air in bilateral subarachnoid spaces and dilated, air-filled frontal horns exerting mass effect.

Fig. 3

Unenhanced axial CT image through the lateral ventricles shows interval insertion of an extraventricular drain, with its tip in the right frontal horn. Considerable interim reduction in the bilateral subarachnoid free air and mass effect were appreciated.