Tension pneumocephalus from an occult frontal sinus fracture following pituitary macroadenoma resection

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management 2020-12, Vol.22, p.100880, Article 100880
• Main Authors: Westrup, Alison M., Parker, Amy B., McKinney, Kibwei A., Glenn, Chad A.
• Format: Article
• Language: English
• Subjects: Case report; Macroadenoma resection; Neurological surgery; Occult; Tension pneumocephalus; Trans-sphenoidal
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2020.100880

Tension pneumocephalus (TP), or the presence of intracranial air with additional neurologic decline, is a common complication after sinonasal surgery due to inadvertent iatrogenic damage to the dura and/or surrounding bony structures. We present the case of a 69-year-old man who underwent routine trans-sphenoidal resection of a pituitary macroadenoma with an uncomplicated hospital and discharge course. The patient subsequently developed sepsis and meningitis, and a spontaneous unilateral TP developed amidst the treatment course. Intraoperatively, no active leaks or post-operative injuries were discovered. However, on post-operative imaging, an occult, bony defect was found located in the right posterior table of the frontal sinus. The patient progressively improved to stable CT Brain over 14 days with the use of short term 100% inspired oxygen and bedside subdural port placement. This report highlights the impact of remote trauma in development of delayed tension pneumocephalus following endoscopic endonasal surgery. The clinical history, presentation, and management are reviewed.