Background:
Pneumocephalus (PNC) is a well-described consequence in postoperative settings and skull fractures that is usually self-limiting. It can get complicated into tension PNC on some rare occasions, leading to an intracranial mass effect. PNC was also reported after unintentional dural puncture throughout the epidural anesthesia process. However, tension PNC resulting from epidural anesthesia procedures is an extremely rare outcome that implies urgent intervention to relieve the tension within the brain. Here, we report a case of an extensive tension intraventricular PNC 2 days following an epidural anesthesia procedure for a femur fixation surgery.
Case Description:
A 23-year-old male presented to the emergency department with basal skull fractures and a femur fracture due to a motorcycle accident. His skull base fracture was managed conservatively then he underwent a femur fixation procedure under epidural anesthesia. Two days after, he developed a severe headache with a disturbed level of consciousness. Computed tomography of the brain revealed an extensive PNC that involved all the subarachnoid spaces down to the cervical region and compressing the cerebellum, which was not found in the initial imaging. The patient’s status improved after the twist-drill burr-hole evacuation of air under the water seal.
Conclusion:
Extensive tension PNC can occur after traumatic brain injury, especially after epidural anesthesia. Such cases should gain high focus because they may differ from simple PNC regarding diagnosis, treatment, and follow-up.
Introduction: Central giant-cell is a benign lesion that predominantly involves the bone of the mandible and maxilla with a wide variation of its behavior. Surgery usually is the first choice in treatment of central giant cell granuloma. Case Report: In this case report we present a 29 years-old female with well define swelling on left maxilla. Diagnosis through incisional biopsy showed a central giant cell granuloma. Surgery with curettage was our treatment option with a follow up( 2 years ), No recurrence was reported. Discussion: Information on the maxillary central giant cell granuloma in published studies is insufficient. So here we present our case as unusual case presentation. Differential diagnosis of this case included osteosarcoma (parosteal type) since the tumor clinical presentation in periosteous tissue adjacent to the bone cortex and showed rapid growth. We chose the conventional surgical treatment by simple surgical curettage by mid-face degloving approach to avoid any facial scaring.
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