Is Fluoroscopy-Guided Drainage of Tension Pneumocephalus an Appropriate Intervention?: Surgical Technique

Tension pneumocephalus is not a common entity after head trauma. It requires urgent intervention when associated with raised intracranial pressure. A 22 year-old man was admitted in our emergency unit after being involved in a traffic accident. Initial assessment of the patient revealed a Gloskow Coma Score (GCS) of 8. Radiological exams showed left fronto-orbital depression fracture, left fronto-basal fracture and left frontal cerebral contusion. The patient was operated urgently. Depressed bones were elevated and cranial reconstruction was done. After the initial operation, his neurological level elevated day by day. Thirty days after the operation computed tomography (CT) scan showed left frontal pneumocephalus. Conservative treatment was initiated. First, the volume of air in the field decreased spontaneously but after strong coughing, the amount of air increased and showed resistance to absorption. The patient was reoperated. Left frontal pneumatic space was irrigated with physiologic saline until all air was evacuated. Fluoroscopy showed the location of the intracranial air and no air was left after evacuation. The patient recovered well. No intracranial air was detected in his follow-up. There is no standard surgical intervention for tension pneumocephalus. Fluoroscopy-guided drainage with punctuation needle for tension pneumocephalus is a minimally invasive and effective procedure.