SPONTANEOUS CHRONIC EPIDURAL PNEUMOCEPHALUS RESULTING FROM HYPERPNEUMATIZATION OF THE CRANIUM CAUSING MASS EFFECT - CASE-REPORT

OBJECTIVE AND IMPORTANCE: We report a rare case of spontaneous epidura l pneumocephalus resulting from an unusual boney defect caused by hype rpneumatization of the cranium. The pneumocephalus was also unusual fo r its chronicity and significant mass effect. CLINICAL PRESENTATION: A 49-year-old man presented with a 3-year history of diffuse headaches and sensation of air movement in his sinuses on the right side. An eva luation for suspected sinusitis using computed tomography determined e xtensive pneumatization of most of the cranium, a large accumulation o f epidural air, and a critical degree of brain shift. INTERVENTION: A right frontoparietal-temporal craniotomy with an osteo-plastic bone fl ap was performed. The floor of the middle cranial fossa and the inner table of the bone flap were extensively debrided of air cells. A large pericranial flap was turned down over the floor of the middle cranial fossa and was held in place by a fat graft. After closing the craniot omy, a tympanostomy tube was placed into the right tympanic membrane. CONCLUSION: The incidence of hyperpneumatization of the cranium seems to be very low. Hyperpneumatization when present, however, can cause s pontaneous intracranial pneumocephalus. Based on the literature and th e success of this case, the optimal management is surgical obliteratio n of the involved air cells.