台灣外科醫學會雜誌

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篇名	Tension Pneumocephalus: Report of Two Cases
作者	Te-Cheng Yueh, Kuang-Chen Hung, Dyi-Sheng Chang
卷期/出版年月	39卷1期 (2006/2)
頁次	38-42
摘要	Tension pneumocephalus is the presence of intracranial air under pressure which can cause rapid neurological deterioration requiring emergency surgery. This is a report of two cases of intracranial tension pneumocephalus. The first patient had a history of emergent craniotomy due to a traumatic frontal depressed skull fracture with minimal pneumocephalus. He complained of progressive weakness in the left limbs and urinary incontinence 32 months after his head injury. A brain computed tomographic scan showed compressive pneumo-ventricle and pneumocephalus. The second patient complained of persistent headache and cerebrospinal fluid (CSF) rhinorrhea two weeks after a road traffic accident. The brain computed tomographic scan demonstrated a massive accumulation of air in the subarachnoid space of the cranial cavity having a compressive effect on the brain. The first patient underwent a pterional approach craniotomy and the dural defect was repaired with a dura substitute( Neuropatch). The second patient underwent a bicoronal craniotomy with temporal muscle fascia graft packing. The clinical symptoms of both patients improved after the operations without neurological deficits. The diagnosis of pneumocephalus is made according to clinical signs and the presence of intracranial air shown in the brain computed tomographic scan. The main cause of failure of this treatment is the lack of repair of the dural tear. Medical practitioners should always keep in mind the possibility of tension pneumocephalus when patients having skull fractures complain of headaches and neurological deterioration. Brain computed tomography is an effective tool in the early diagnosis of tension pneumocephalus.
關鍵詞	brain injury, cerebrospinal fluid leak, tension pneumocephalus
分類	Case Report