Tension pneumocephalus is a rare complication of functional endoscopic sinus surgery that may lead to rapid neurologic deterioration. Patients typically display symptoms within hours after the operation, and computed tomography reveals the presence of a skull base defect. We report a unique case of subacute tension pneumocephalus with no obvious skull base defect, which was associated with a pupil-involving third-nerve palsy. Wediscuss management of this complication and preventive measures for avoiding pneumocephalus after functional endoscopic sinus surgery.
References
1.
MarkhamJ.W.The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien)1967; 16(1): 1–78.
2.
CartwrightM.J., EisenbergM.B.Tension pneumocephalus associated with rupture of a middle fossa encephalocele. Case report. J Neurosurg1992; 76(2): 292–5.
3.
FinchM.D., MorganG.A.Traumatic pneumocephalus following head injury. A complication of general anaesthesia. Anaesthesia1991; 46(5): 385–7.
4.
ClevensR.A., BradfordC.R., WolfG.T.Tension pneumocephalus after endoscopic sinus surgery. Ann Otol Rhinol Laryngol1994; 103(3): 235–7.
5.
DavisD.H., LawsERJr., McDonaldT.J.Intraventricular tension pneumocephalus as a complication of paranasal sinus surgery: Case report. Neurosurgery1981; 8(5): 574–6.
6.
LawsonW.The intranasal ethmoidectomy: Evolution and an assessment of the procedure. Laryngoscope1994(6 Pt 2); 104: 1–49.
7.
MayM., LevineH.L., MesterS.J., SchaitkinB.Complications of endoscopic sinus surgery: Analysis of 2108 patients—incidence and prevention. Laryngoscope1994; 104(9): 1080–3.
8.
ChurchC.A., ChiuA.G., VaughanW.C.Endoscopic repair of large skull base defects after powered sinus surgery. Otolaryngol Head Neck Surg2003; 129(3): 204–9.
9.
AferzonM., AferzonJ., SpektorZ.Endoscopic repair of tension pneumocephalus. Otolaryngol Head Neck Surg2001; 124(6): 688–9.
10.
DandyW.E.Pneumocephalus (intracranial pneumatocoele or aerocoele). Arch Surg1926; 12: 940–82.
11.
HorowitzM.Intracranial pneumocoele. An unusual complication following mastoid surgery. J Laryngol Otol1964; 78: 128–34.
BurnsJ.A., DodsonE.E., GrossC.W.Transnasal endoscopic repair of cranionasal fistulae: A refined technique with long-term follow-up. Laryngoscope1996; 106(9 Pt 1): 1080–3.
14.
LanzaD.C., O'BrienD.A., KennedyD.W.Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope1996; 106(9 Pt 1): 1119–25.
15.
ClevensR.A., MarentetteL.J., EsclamadoR.M.Incidence and management of tension pneumocephalus after anterior craniofacial resection: Case reports and review of the literature. Otolaryngol Head Neck Surg1999; 120(4): 579–83.
