Tension pneumocephalus

Case contributed by Dr Jeffrey Alexis

Presentation

Patient presented for elective left orbital exenteration and flap repair in the context of left medial canthus squamous cell carcinoma. He was found to be difficult to rouse post-anaesthetic. A non-contrast CT brain was performed post-operatively.

Patient Data

Age: 90 years
Gender: Male
CT

A non-constrast CT brain demonstrated extensive subdural air causing a mass effect on the underlying brain parenchyma consistent with a tension pneumocephaly. The imaging sign featured here is the Mount Fuji sign which involves separation of the frontal lobes simulating the appearance of a silhouette of Mount Fuji. Another sign of pneumocephalus demonstrated here is the air bubble sign which reflects small collections of air within the subarachnoid space. 

Case Discussion

Urgent neurosurgical intervention with decompression was performed and the patient made a good recovery. This is an example of a rare surgical complication of orbital exenteration. The mechanism was likely due to a ball-valve effect causing a one-way communication of air via the surgical flap into the dural space.

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Case information

rID: 68605
Published: 12th Jul 2019
Last edited: 12th Jul 2019
Inclusion in quiz mode: Included
Institution: Gold Coast Health

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