Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage

Abstract

Background: Tension pneumocephalus is a neurosurgical emergency caused by progressive accumulation of air in the intracranial spaces mediated by a valve mechanism. Tension pneumocephalus usually presents with headaches, reduced consciousness, and even death. One of the most common causes is an ethmoidal defect resulted by nasal surgery or facial traumas.

Methods: A literature review about tension pneumocephalus resulting from ethmoidal damages was performed. Surgery strategies included decompression by frontal burr holes and multilayer repair of the ethmoidal defect. In this paper, an endoscopic technique that exploits the ethmoidal defect to decompress the intracranial spaces and to resolve tension pneumocephalus with fewer complications and shorter hospitalization in comparison to frontal craniotomy is proposed.

Conclusion: The proposed endonasal endoscopic technique could be effectively used as a first-line treatment for symptomatic tension pneumocephalus caused by posttraumatic or iatrogenic ethmoidal defect.

Figure 1

(a) Anterior skull base defect exposure; (b) enlargement of the breach to remove valve action and sharp edges; (c) cauterizing small bleeding vessels surrounding the bone rupture; (d–f) instillation of warmed normal saline. Note that the air bubble blowing out: (g) sealing the defect with a thigh fat plug, (h) fascia lata insertion, and (i) modified Hadad flap.