Pneumocephalus after Tympanomastoidectomy: A Case Presentation

Document Type: Case Report


1 Department of Otolaryngology- Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

2 Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.


Pneumocephalus is the presence of air or gas within the cranial cavity. It can occur following otorhinolaryngological procedures. A small pneumocephalus spontaneously heals without any treatment. In severe cases, conservative therapy includes a 30-degree head elevation, avoidance of the Valsalva maneuver, analgesics, osmotic diuretics, and oxygen therapy.
Case Report:
A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.
Pneumocephalus should be considered a post-operative complication of tympanomastoidectomy. In most cases, pneumocephalus responds to conservative therapy. Supplemental oxygen increases the rate of absorption of pneumocephalus. Serial imaging is needed to ensure gradual reduction of the pneumocephalus.


Main Subjects

1. Kuo M-Y, Lien W-C, Wang H-P, Chen W-J. Nontraumatic tension pneumocephalus – a differential diagnosis of headache at the ED. Am J Emerg Med. 2005; 23(2):235–6.

2. Sawant R, Trinidade A, Das T. A spontaneous Pneumocephalus and Hyperpneumatisation of occipital bone and atlas vertebra: a case report. IOSR Journal of Dental and Medical Sciences.2016; 15(8):11-4.

3. Schirmer CM, Heilman CB, Bhardwaj A. Pneumocephalus: case illustrations and review. Neurocrit care. 2010; 13(1):152–8.

4. Wolff E. Air accumulation in the right lateral ventricle of the brain (Pneumocephalus) (article in German). Münch Med Wochenschr.1914; 61:899.

5. Ectors L. Chronic subdural hematoma. Surgical treatment  (article in French) Acta Chir Belg. 1962; 6: 570–606.

6. Solomiichuk VO, Lebed VO, Drizhdov KI. Posttraumatic delayed subdural tension pneumocephalus. Surg Neurol Int.  2013; 4:37.

7. Ruiz-Juretschke F, Mateo-Sierra O, Iza-Vallejo B,
Carrillo-Yagüe R. Intraventricular tension pneumocephalus after transsphenoidal surgery: A case report and literature review. Neurocirugia (Astur). 2007; 18 (2):134–7.

8. Aoki N, Sakai T. Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults. Acta Neurochir. 1993; 120(1-2):44–6.

9. Monajati A, Cotanch WW. Subdural tension pneumocephalus following surgery. J Comput Assist Tomogr. 1982;6(5):902–6.

10. Karavelioglu E, Eser O, Haktanir A. Pneumocephalus and pneumorrhachis after spinal surgery: Case report and review of the literature. Neurol Med Chir. 2014;54(5):405–7.

11.Ishiwata Y, Fujitsu K, Sekino T, Fujino H, Kubokura T, Tsubone K, et al. Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg. 1988; 68(1):

12. Agrawal A, Singh BR. Mount Fuji sign with concavo-convex appearance of epidural haematoma in a patient with tension pneumocephalus. J Radiol Case Rep. 2009; 3 (1):10–2.

13. Kankane VK, Jaiswal G, Gupta TK. Posttraumatic delayed tension pneumocephalus: Rare case with review of literature. Asian J Neurosurg. 2016; 11(4):343–7.

14. Penrose-Stevens A, Ibrahim A, Redfern R. Localized pneumocephalus caused by Clostridium perfringens meningitis. Br J Neurosurg. 1999;

15. Dubey SP, Jacob O, Gandhi M. Postmasto- idectomy pneumocephalus: case report. Skull Base. 2002; 12(3):167–73.

16. Lee DH, Cho HH, Cho YB. Pneumocephalus secondary to mastoid surgery: A case report. Auris Nasus Larynx. 2007; 34(1):91-3.

17. Bernstein AL, Cassidy J, Duchynski R, Eisenberg SS. Atypical headache after prolonged treatment with nasal continuous positive airway pressure. Headache: The Journal of Head and Face Pain. 2005; 45(5):609-11.

18. Paiva-NetoMAd, Tella-Jr OId.Supra-orbital keyhole removal of anterior fossa and parasellar meningiomas. Arquivos de neuro-psiquiatria. 2010; 68(3):418-23.