Tension pneumocephalus causing brain herniation after endoscopic sinus surgery.

Area of Science:

• Neurosurgery
• Otolaryngology
• Medical Case Reports

Background:

• Endoscopic sinus surgery (ESS) is a common procedure for sinonasal diseases.
• Intracranial complications following ESS are rare but can be serious.
• Cerebrospinal fluid fistulas are the most frequent intracranial complication of ESS.

Observation:

• Pneumocephalus, the presence of air within the cranial cavity, is an exceptionally rare complication of ESS.
• This report details a unique case of tension pneumocephalus developing post-ESS.
• The tension pneumocephalus in this case led to significant intracranial pressure and brain herniation.

Findings:

• The presented case is the first documented instance of tension pneumocephalus causing brain herniation as a direct complication of endoscopic sinus surgery.
• Prompt diagnosis and surgical intervention were critical for patient management.
• Emergent craniotomy was successfully performed to decompress the brain and address the complication.

Implications:

• This case underscores the importance of recognizing rare but life-threatening complications of ESS.
• It highlights the potential for pneumocephalus, particularly tension pneumocephalus, following sinonasal endoscopic procedures.
• Awareness among surgeons is crucial for timely diagnosis and management of such severe intracranial events.