Download PDF
J Neurol Surg B Skull Base 2019; 80(04): 424-430
DOI: 10.1055/s-0038-1676036
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Otogenic Pneumocephalus: Case Series and Update on Management

Michael Eggerstedt
1   Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
,
Scott Hong
2   Rush Medical College, Chicago, Illinois, United States
,
Daniel B. Eddelman
3   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Ryan M. Smith
1   Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
,
Lorenzo Munoz
3   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
Rich W. Byrne
3   Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, United States
,
R. Mark Wiet
1   Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, United States
› Author Affiliations
Further Information

Publication History

09 August 2018

11 October 2018

Publication Date:
19 November 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Objectives This study is aimed to report the largest independent case series of spontaneous otogenic pneumocephalus (SOP) and review its pathophysiology, clinical presentation, and treatment.

Design Four patients underwent a middle cranial fossa approach for repair of the tegmen tympani and tegmen mastoideum. A comprehensive review of the literature regarding this disease entity was performed.

Setting U.S. tertiary academic medical center.

Participants: Patients presenting to the lead author's clinic or to the emergency department with radiographic evidence of SOP. Symptoms included headache, otalgia, and neurologic deficits.

Main Outcome Measures Patients were assessed for length of stay, postoperative length of stay, and neurologic outcome. Three of four patients returned to their neurologic baseline following repair.

Results Four patients were successfully managed via a middle cranial fossa approach to repairing the tegmen mastoideum.

Conclusion The middle cranial fossa approach is an effective strategy to repair defects of the tegmen mastoideum. SOP remains a clinically rare disease, with little published information on its diagnosis and treatment.

Keywords

pneumocephalus - otogenic - tegmen - middle cranial fossa
 

  • References

  • 1 Abbati SG, Torino RR. Spontaneous intraparenchymal otogenic pneumocephalus: a case report and review of literature. Surg Neurol Int 2012; 3: 32
    CrossrefPubMedSearch in Google Scholar
  • 2 Stevens SM, Lambert PR, Rizk H, McIlwain WR, Nguyen SA, Meyer TA. Novel radiographic measurement algorithm demonstrating a link between obesity and lateral skull base attenuation. Otolaryngol Head Neck Surg 2015; 152 (01) 172-179
    CrossrefPubMedSearch in Google Scholar
  • 3 Goldmann RW. Pneumocephalus as a consequence of barotrauma. JAMA 1986; 255 (22) 3154-3156
    CrossrefPubMedSearch in Google Scholar
  • 4 Markham JW. The clinical features of pneumocephalus based upon a survey of 284 cases with report of 11 additional cases. Acta Neurochir (Wien) 1967; 16 (01) 1-78
    CrossrefPubMedSearch in Google Scholar
  • 5 Dandy WE. Pneumocephalus (intracranial pneumatocele or aerocele). Arch Surg 1926; 12: 949-982
    CrossrefPubMedSearch in Google Scholar
  • 6 Horowitz M. Intracranial pneumocoele. An unusual complication following mastoid surgery. J Laryngol Otol 1964; 78: 128-134
    CrossrefPubMedSearch in Google Scholar
  • 7 Mylonas C. Delayed pneumocephalus in patients with CSF shunts. Br J Neurosurg 1991; 5 (01) 67-72
    CrossrefPubMedSearch in Google Scholar
  • 8 Lee SC, Lueck CJ. Cerebrospinal fluid pressure in adults. J Neuroophthalmol 2014; 34 (03) 278-283
    CrossrefPubMedSearch in Google Scholar
  • 9 Cisneros AI, Whyte J, Martínez C. , et al. Radiological patterns of the bony roof of the superior semicircular canal. Surg Radiol Anat 2013; 35 (01) 61-65
    CrossrefPubMedSearch in Google Scholar
  • 10 Davey S, Kelly-Morland C, Phillips JS, Nunney I, Pawaroo D. Assessment of superior semicircular canal thickness with advancing age. Laryngoscope 2015; 125 (08) 1940-1945
    CrossrefPubMedSearch in Google Scholar
  • 11 Lee DH, Jun BC, Kim DG, Jung MK, Yeo SW. Volume variation of mastoid pneumatization in different age groups: a study by three-dimensional reconstruction based on computed tomography images. Surg Radiol Anat 2005; 27 (01) 37-42
    CrossrefPubMedSearch in Google Scholar
  • 12 Nyrop M, Bjerre PK, Christensen J, Jørgensen KE. Extensive and symptomatic cranial pneumatization: caused by frequent performance of Valsalva's manoeuvre?. J Laryngol Otol 1999; 113 (05) 480-482
    CrossrefPubMedSearch in Google Scholar
  • 13 Hage P, Daou B, Jabbour P. Spontaneous otogenic pneumocephalus due to altitude changes: a case report and review of literature. Clin Neurol Neurosurg 2015; 138: 162-164
    CrossrefPubMedSearch in Google Scholar
  • 14 Jelsma F, Moore DF. Cranial aerocele. Am J Surg 1954; 87 (03) 437-451
    CrossrefPubMedSearch in Google Scholar
  • 15 Añorbe E, Aisa P, Saenz de Ormijana J. Spontaneous pneumatocele and pneumocephalus associated with mastoid hyperpneumatization. Eur J Radiol 2000; 36 (03) 158-160
    CrossrefPubMedSearch in Google Scholar
  • 16 Richards SD, Saeed SR, Laitt R, Ramsden RT. Hypercellularity of the mastoid as a cause of spontaneous pneumocephalus. J Laryngol Otol 2004; 118 (06) 474-476
    CrossrefPubMedSearch in Google Scholar
  • 17 Pennings RJ, Liauw L, Cremers CW. A spontaneous otogenic extradural pneumocephalus. Otol Neurotol 2009; 30 (06) 864
    CrossrefPubMedSearch in Google Scholar
  • 18 Mohammed R, Profant M. Spontaneous otogenic pneumocephalus. Acta Otolaryngol 2011; 131 (06) 670-674
    CrossrefPubMedSearch in Google Scholar
  • 19 Zhao N, Wang DD, Huang X, Karri SK, Wu H, Zheng M. Spontaneous otogenic pneumocephalus presenting with occipital subcutaneous emphysema as primary symptom: could tension gas cause the destruction of cranial bones?. J Neurosurg 2011; 115 (04) 679-683
    CrossrefPubMedSearch in Google Scholar
  • 20 Siegel JL, Hampton K, Rabinstein AA, McLaughlin D, Diaz-Gomez JL. Oxygen therapy with high-flow nasal cannula as an effective treatment for perioperative pneumocephalus: case illustrations and pathophysiological review. Neurocrit Care 2017 (e-pub ahead of print) Doi: 10.1007/s12028-017-0464-x
    PubMedSearch in Google Scholar
  • 21 Wanna G, Young JA, Swanson E, Haynes D. Spontaneous otogenic posterior fossa pneumocephalus. Otolaryngol Head Neck Surg 2010; 143 (04) 593-594
    CrossrefPubMedSearch in Google Scholar
  • 22 Hyam JA, Morgan L, Mendoza ND. Coma caused by spontaneous otogenic pneumocephalus. Clin Neurol Neurosurg 2008; 110 (01) 62-64
    CrossrefPubMedSearch in Google Scholar
  • 23 Stavas J, McGeachie RE, Turner DA, Nelson MJ. Symptomatic intracranial pneumatocele from mastoid sinus of spontaneous origin. Case report. J Neurosurg 1987; 67 (05) 773-775
    CrossrefPubMedSearch in Google Scholar
  • 24 Madeira JT, Summers GW. Epidural mastoid pneumatocele. Radiology 1977; 122 (03) 727-728
    CrossrefPubMedSearch in Google Scholar
  • 25 Ahren C, Thulin CA. Lethal intracranial complication following in inflation in the external auditory canal in treatment of serous otitis media and due to defects in the petrous bone. Acta Otolaryngol 1965; 60 (1–6): 407-421
    CrossrefPubMedSearch in Google Scholar
  • 26 Wilkinson EP, Meyer TA, Rubinstein JT. Spontaneous otogenic pneumocephalus managed with the middle fossa approach. Acta Otolaryngol 2007; 127 (08) 892-896
    CrossrefPubMedSearch in Google Scholar
  • 27 Singh A, Alvarez J. Spontaneous otogenic intracerebral pneumocephalus. West J Emerg Med 2010; 11 (01) 107
    PubMedSearch in Google Scholar
  • 28 Krayenbühl N, Alkadhi H, Jung HH, Yonekawa Y. Spontaneous otogenic intracerebral pneumocephalus: case report and review of the literature. Eur Arch Otorhinolaryngol 2005; 262 (02) 135-138
    CrossrefPubMedSearch in Google Scholar
  • 29 Dowd GC, Molony TB, Voorhies RM. Spontaneous otogenic pneumocephalus. Case report and review of the literature. J Neurosurg 1998; 89 (06) 1036-1039
    CrossrefPubMedSearch in Google Scholar
  • 30 Bahloul K, Kalamarides M, Bouccara D, Sterkers O, Rey A. [Spontaneous otogenic pneumocephalus]. Neurochirurgie 2003; 49 (2,3; Pt 1): 110-113
    PubMedSearch in Google Scholar