John D. Chovan, James R. Cacchillo
Brain Damage, Cranial Surgery
Medical Pathology | Neurology | Nursing
Pneumocephalus is defined as the presence of air within the cranial vault; tension pneumocephalus occurs when air within the cranial vault becomes trapped and causes a mass effect or increased pressure, damaging the brain (Patel, Idicula, Carrau, & Prevedello, 2013). Small amounts of air within the cranial vault can be reabsorbed or metabolized by the body over a few days without causing symptoms, however, in tension pneumocephalus the air cannot escape, causing extensive neurological symptoms (Webber-Jones ,2005). Thus, asymptomatic pneumocephalus can be a common finding following a cranial surgery, where as tension pneumocephalus is extremely rare (Webber-Jones, 2005). Markam (1967) noted that H. Chiari was the first to describe intracranial pneumocephalus in an autopsy he performed of a patient who died from ethmoiditis in 1884. W. H. Luckett was the first to use x-ray diagnostics to establish a diagnosis of pneumocephalus in 1913, and E. Wolff was the first to coin the term “pneumozephalus” in 1914 (Markham, 1967, p. 2). Of the 295 pneumocephalus cases reviewed, Markham (1967) reported that 218 were attributed to trauma, 38 to a neoplasm, 26 to infection, 11 were postoperative, and 2 were idiopathic (p.13). Revealing even a small amount of intracranial air (0.5ml), a non-contrast CT scan is the diagnostic tool of choice for tension pneumocephalus, as it can also exclude other diagnoses (Simmons & Luks, 2013). Mount Fuji sign is a CT scan finding in which a subdural air collection causes compression and separation to the frontal lobes giving a peaked appearance similar to the peaks of Mount Fuji (see Figures 1 & 2) (Michel, 2004). The Mount Fuji sign is associated in patients with tension pneumocephalus (see Figure 1 & 2) (Michel, 2004). Tension pneumocephalus is a surgical emergency requiring immediate attention (Patel et al., 2013). Without immediate and aggressive treatment, and in some cases even with treatment, neurological deterioration, cerebral cellular infarct and brain herniation can result, ultimately leading to death (Wohlgemuth, 1985). Thus, tension pneumocephalus has a high morbidity and mortality, if not recognized early with prompt intervention.
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