Pneumocephalus following treatment of a stapes gusher

A case history is presented of a patient who underwent stapedectomy complicated by a cerebrospinal fluid (CSF) gusher. A persistent postoperative CSF leak was controlled by elevation of the head and spinal drainage. Retrograde passage of air through a labyrinthine fistula, however, resulted in pneumocephalus and transient neurologic deficit. This is a rare but serious complication of treatment of a stapes gusher which demonstrates the potential for entry of air intracranially in the presence of a perilymph fistula.