Intracerebral pneumatocele: An unusual complication following intraventricular drainage in a case of benign intracranial hypertension

Abstract

The development of an intracerebral pneumatocele following ventricular catheterization for benign intracranial hypertension is described. The importance of skull radiography in the diagnosis of this previously unreported complication ist emphasized. This case demonstrates that air can accumulate without the need to implicate increased pharyngeal pressure, and despite raised intracranial pressure.

Tension pneumocephalus after frontal sinus gunshot wound

“…[6][7][8] Pneumocephalus can result from infections of the paranasal sinuses or petrous temporal bone, 3 from cerebral abscess, 9,10 and after craniotomy or intraventricular drainage. 11 On rare occasions, pneumocephalus may develop after a penetrating head injury, 4 as observed in our case. A prerequisite for the formation of an expanding aerocele is an intracranial pressure gradient that leads to the ingress of air.…”

“…Frontoethmoid injuries have predominated because of the obvious predisposition of the anterior cranial fossa to fracture in motor vehicle accidents and frontal assault 6‐8 . Pneumocephalus can result from infections of the paranasal sinuses or petrous temporal bone, 3 from cerebral abscess, 9,10 and after craniotomy or intraventricular drainage 11 . On rare occasions, pneumocephalus may develop after a penetrating head injury, 4 as observed in our case.…”

Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: A prospective study

“…The diffusion of nitrous oxide into the entrapped air owing to its greater solubility in blood and the fact that nitrous oxide has a higher partial pressure than nitrogen has also been implicated in further increasing the size of the pneumocephalus l, 8,11,13,16,22 and thus in its tendency to progress towards tension pneumoeephalus. However, nitrous oxide can diffuse out of the air-filled space as fast as it diffuses into it.…”

“Post Traumatic Brain Abscess Mimicking as Pneumatocele”: An Uncommon Presentation

“…Pneumocephalus after intracranial surgery or as a result of any eroding infection or neoplasm is common. Other causes of pneumocephalus include gunshot injury, 4,5 frontal sinus osteoma, 6,7 intraventricular drainage, 8 spontaneous cure of intracerebral hematoma by drainage into middle ear and replacement of the hematoma by air, 9 and following manually operated ventilation with a mask. 10 Air in brain parenchyma following head injury involving the fracture of air sinuses could also be due to cortical laceration following impingement of fractured fragments of air sinuses into the brain parenchyma and air dissecting into the parenchyma and collecting into a cavity.…”