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A Rare Case of Tension Pneumocephalus with Spontaneous CSF Rhinorrhea Managed by Endoscopic Trans-Sphenoidal CSF Leak

T S Sangeetha1, A Muraleedharan1

  • 1Department of ENT, Gleneagles Global Health City, Chennai, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|May 19, 2023
PubMed

Insights

Tension pneumocephalus, a rare condition associated with spontaneous cerebrospinal fluid (CSF) rhinorrhea, requires prompt diagnosis and endoscopic repair. Early intervention is crucial to prevent serious neurological complications.

Area of Science:

  • Neurosurgery
  • Rhinology
  • Neurology

Background:

  • Tension pneumocephalus and spontaneous cerebrospinal fluid (CSF) rhinorrhea are infrequently encountered clinical conditions.
  • A rare association between these two conditions necessitates understanding their interplay and management.

Purpose of the Study:

  • To report a rare case of tension pneumocephalus secondary to spontaneous CSF rhinorrhea.
  • To highlight the diagnostic modalities and successful surgical management of this rare association.

Main Methods:

  • A 65-year-old male presented with symptoms of clear rhinorrhea, headache, vomiting, and lethargy.
  • Diagnostic imaging included MR cisternography and CT paranasal sinuses.
  • Treatment involved prompt endoscopic trans-sphenoidal CSF leak repair.

Main Results:

  • Imaging revealed significant tension pneumocephalus with a defect in the posterior sphenoid sinus wall and CSF pooling.
  • Endoscopic repair of the CSF leak resulted in complete resolution of tension pneumocephalus within four postoperative days.
  • The patient experienced complete symptom resolution post-surgery.

Conclusions:

  • Tension pneumocephalus associated with spontaneous CSF rhinorrhea, though rare, requires timely diagnosis and intervention.
  • Endoscopic trans-sphenoidal surgery is an effective treatment for CSF leaks causing tension pneumocephalus.
  • Prompt diagnosis and surgical repair are vital to avert potential neurological sequelae.
Keywords:
Endoscopic CSF leak repairSpontaneous CSF rhinorrheaTension pneumocephalus

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