IATROGENIC PNEUMOCEPHALUS IN A MAN WITH UNDIFFERENTIATED NASOPHARYNGEAL CARCINOMA - A CASE-REPORT

A case of pneumocephalus in a 45-year-old male with undifferentiated r hinopharyngeal carcinoma is described. The patient was initially subje cted to radiotherapy and then to transmaxillary resection and a second course of stereotactic radiotherapy for recurrent disease. Lastly, th e patient was treated with chemotherapy because of local-regional dise ase progression, After two cycles of cisplatin, adria-blastine and ble omycin, the patient suddenly entered in coma. Cerebral CT scan evidenc ed the presence of air in the frontal and lateral cornua, in the subar achnoid space of the base cisternae extending to the 7th cervical vert ebra. After 8 months of a clinical stationary condition, the patient d ied. The various treatments used are critically reviewed, and modern t herapeutic approaches for the neoplasm and the toxicity involved are d iscussed. We conclude that in nasopharyngeal carcinoma, for patients w ho relapse after radiotherapy, successive focal-regional therapies (su rgery, re-irradation) should be carefully evaluated to avoid demolishi ng treatments, which are burdened with severe side effects that might influence the quality of life with only slight improvement of overall survival. Furthermore, the presence of persistant aqueous rhinorrhea i n these patients should be carefully evaluated, because it could be an early symptom of a cerebrospinal fluid leak.