TENSION PNEUMOCEPHALUS FOLLOWING CRANIOFACIAL RESECTION

Background. The craniofacial approach is a reliable method for excisin g tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and menin gitis are well-known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clini cal manifestations, radiographic features, and treatment of tension pn eumocephalus. Methods. Case study. We reviewed the records of all pati ents who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identifi ed, 2 had tension pneumocephalus. Results. Neurologic deterioration af ter anterior craniofacial resection occurred in both patients in the i mmediate postoperative period. Both patients had extradural intracrani al air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by cath eter drainage, and the second patient was treated with needle aspirati on followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental s tatus did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline. Conclusions . Tension pneumocephalus is a potentially devastating complication tha t may occur after craniofacial resection. It requires prompt recogniti on and treatment to minimize morbidity. (C) 1995 John Wiley and Sons, Inc.