Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Abstract

Tension pneumocephalus (TP) is a rare complication following skull base surgery with potentially deadly consequences if not recognized and treated quickly. Characterized by the presence of air with a pressure gradient inside of the intracranial vault capable of causing mass effect, TP can result in altered mental status, seizures, or even death. We present the case of a 52-year-old male with recurrent hemangiopericytoma who underwent tumor resection and reconstruction complicated by tension pneumocephalus. It was determined to be caused by a failure of the drain site closure in the setting of a lumbar drain, thus resulting in an “inverted soda bottle” effect leading to TP. We review the reported cases of TP in skull base surgery and highlight the importance of ensuring drain site closure in order to prevent the development of tension pneumocephalus after skull base surgery.