Intracerebral pneumatocele presenting after air travel

Restricted access

✓ In this report the authors discuss a patient who experienced symptoms of an acute right frontal, intraparenchymal pneumatocele while on an airplane descending to an international airport. This rare complication of an ethmoid sinus osteoma that eroded upward through the dura mater is described along with a literature review. A persistent headache and inappropriate behavior consistent with a frontal lobe syndrome brought the patient to clinical and imaging evaluation, which revealed a large right frontal lobe pneumatocele and an associated ethmoid sinus osteoma extending upward into the frontal lobe. Through a right frontal craniotomy, the air cavity was evacuated, the osteoma partially excised, and the dural defect closed using a vascularized pericranial flap. Postoperatively, the patient made an unremarkable recovery. For patients with air sinus osteomas extending into the cranial cavity, air travel or other barotrauma may result in a life-threatening tension pneumatocele.

Article Information

Address reprint requests to: Raman C. Mahabir, M.D., Department of Surgery, Foothills Medical Centre, 1403 29th Street N.W, Calgary, Alberta, T2N 2T9, Canada. email: raman_chaos@hotmail.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Preoperative nonenhanced coronal CT scans revealing a large air collection in the right anterior frontal lobe that is associated with ventricle compression, a midline shift, and subfalcine herniation. The osteoma is apparent (center and right).

  • View in gallery

    Preoperative nonenhanced axial CT scans further clarifying that the air is intraparenchymal and the osteoma extends upward from the ethmoid sinus into the frontal lobe.

  • View in gallery

    Axial T1-weighted (left), T2-weighted (center), and fluid-attenuated inversion-recovery (right) MR images demonstrating a hypointense mass in the ethmoid sinus as well as an air collection measuring 6.7 × 4.8 × 6.3 cm in the right frontal lobe. There is a significant midline shift and the hyperintensity peripheral to the air collection is consistent with ischemia.

  • View in gallery

    Postoperative nonenhanced axial CT scans demonstrating partial reexpansion of the right frontal lobe and a decrease in the midline shift. Air now extends into the subdural compartment.

  • View in gallery

    Six-month follow-up axial T1-weighted (left) and T2-weighted (right) images demonstrating resolution of the pneumatocele and reexpansion of the frontal lobe. Focal encephalomalacia is noted in the right anterior frontal lobe.

References

  • 1.

    Canavan LOsborn RE: Dural sinus air without head trauma or surgery: CT demonstration. J Comput Assist Tomogr 15:5265271991Canavan L Osborn RE: Dural sinus air without head trauma or surgery: CT demonstration. J Comput Assist Tomogr 15:526–527 1991

    • Search Google Scholar
    • Export Citation
  • 2.

    Chan YPYau CYLewis RRet al: Acute confusion secondary to pneumocephalus in an elderly patient. Age Ageing 29:3653672000Chan YP Yau CY Lewis RR et al: Acute confusion secondary to pneumocephalus in an elderly patient. Age Ageing 29:365–367 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Cushing H: Experiences with orbito-ethmoidal osteomata having intracranial complications, with report of 4 cases. Surg Gynecol Obstet 44:7217421927Cushing H: Experiences with orbito-ethmoidal osteomata having intracranial complications with report of 4 cases. Surg Gynecol Obstet 44:721–742 1927

    • Search Google Scholar
    • Export Citation
  • 4.

    Johnson DTan L: Intraparenchymal tension pneumatocele complicating frontal sinus osteoma: case report. Neurosurgery 50:8788802002Johnson D Tan L: Intraparenchymal tension pneumatocele complicating frontal sinus osteoma: case report. Neurosurgery 50:878–880 2002

    • Search Google Scholar
    • Export Citation
  • 5.

    Markham JW: The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir 16:1781967Markham JW: The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir 16:1–78 1967

    • Search Google Scholar
    • Export Citation
  • 6.

    Osborn AGDaines JHWing SDet al: Intracranial air on computerized tomography. J Neurosurg 48:3553591978Osborn AG Daines JH Wing SD et al: Intracranial air on computerized tomography. J Neurosurg 48:355–359 1978

    • Search Google Scholar
    • Export Citation
  • 7.

    Soucek CD: Pneumocephalus with osteoma. Frontal osteoma. J Kans Med Soc 75:1231241974Soucek CD: Pneumocephalus with osteoma. Frontal osteoma. J Kans Med Soc 75:123–124 1974

    • Search Google Scholar
    • Export Citation
  • 8.

    Steudel WIHackel H: Prognosis, incidence and management of acute traumatic intracranial pneumocephalus. A retrospective analysis of 49 cases. Acta Neurochir 80:93991986Steudel WI Hackel H: Prognosis incidence and management of acute traumatic intracranial pneumocephalus. A retrospective analysis of 49 cases. Acta Neurochir 80:93–99 1986

    • Search Google Scholar
    • Export Citation
  • 9.

    Vallejo LAGil-Carcedo LMBorras JMet al: Spontaneous pneumocephalus of an otogenic origin. Otolaryngol Head Neck Surg 121:6626651999Vallejo LA Gil-Carcedo LM Borras JM et al: Spontaneous pneumocephalus of an otogenic origin. Otolaryngol Head Neck Surg 121:662–665 1999

    • Search Google Scholar
    • Export Citation
  • 10.

    Wu CTLee ST: Delayed spontaneous tension pneumocephalus caused by radionecrosis of the skull base. Br J Neurosurg 13:2142161999Wu CT Lee ST: Delayed spontaneous tension pneumocephalus caused by radionecrosis of the skull base. Br J Neurosurg 13:214–216 1999

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 140 140 13
Full Text Views 147 118 0
PDF Downloads 88 66 0
EPUB Downloads 0 0 0

PubMed

Google Scholar