Giant Spontaneous Epidural Pneumatocele: Case Report and Review of the Literature.

Abstract

BACKGROUND:

Pneumocephalus is a commonly encountered finding in neurosurgery in which air displaces intracranial cerebrospinal fluid after cranial surgery or a cerebrospinal fluid leak into paranasal or mastoid sinuses. When an intracranial air collection becomes chronically established in a fixed loculation causing mass effect, pneumatocele is a more appropriate term. We present an unusual case of a spontaneous giant frontotemporal epidural pneumatocele that persisted for more than 1 year before the patient presented for neurological treatment.

CASE DESCRIPTION:

A 40-year-old man with a remote history of minor head trauma presented with symptoms of headaches, dizziness, and vertigo. Imaging revealed a right giant epidural pneumocephalus secondary to bony dehiscence of the intracranial wall of the mastoid bone. A subtemporal middle fossa approach was performed to repair the mastoid defect with hydroxyapatite, fat graft, and temporalis fascia. The patient was discharged on postoperative day 2 with improvement in his headaches. One month after discharge operative imaging demonstrated complete resolution of his epidural pneumatocele and improvement in his headaches.

CONCLUSIONS:

This unique case represents the first reported case in the neurosurgical literature of a giant spontaneous epidural pneumatocele occurring in an adult treated with a middle fossa approach with resolution on follow-up imaging.

• Authors: Khaled M Krisht, Ilyas M Eli, Cheryl Ann Palmer, Richard H Schmidt
• Journal: World neurosurgery (World Neurosurg) Vol. 84 Issue 6 Pg. 2075.e7-12 (Dec 2015) ISSN: 1878-8769 [Electronic] United States
• PMID: 26183135 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Topics

• Adult
• Cerebrospinal Fluid Leak (surgery)
• Cranial Fossa, Middle (surgery)
• Epidural Space (pathology, surgery)
• Headache (etiology)
• Humans
• Male
• Mastoid (pathology)
• Neurosurgical Procedures (methods)
• Pneumocephalus (etiology, pathology, surgery)
• Treatment Outcome