title: Relief of tension pneumocephalus with endotracheal intubation.
abstract: BACKGROUND
  Pneumocephalus is commonly seen after neurosurgical procedures and is usually of little consequence. When an anatomical 1-way valve develops, there can be significant air entrapment, known as tension pneumocephalus. In cases of craniofacial resection, an iatrogenic ball-valve mechanism involving the nasopharynx can be created.
  
  
  METHODS
  In this case of craniofacial resection, we find that a tension pneumocephalus developed after surgery, resulting in a change in the patient's mental status. A latissimus dorsi muscle flap, which had been created during surgery, was found to pulsate with the patient's respirations. This flap, along with the patient's nasopharynx, created a ball valve mechanism which led to entrapment and accumulation of intracranial air. This case demonstrates the use of endotracheal intubation as a means of bypassing a 1-way valve of this nature.
  
  
  CONCLUSIONS
  Endotracheal intubation in conjunction with twist drill hole aspiration effectively resolves the pneumocephalus by both providing an outlet for trapped air and by removing the ball-valve mechanism from the circuit. Endotracheal intubation should be considered along with twist drill hole aspiration in the emergent management of tension pneumocephalus secondary to a nasopharyngeal ball-valve mechanism.
authors.affiliation: Department of Neurosurgery, UMDNJ New Jersey Medical School, Newark, NJ 07103, USA.
authors.forename: Antonios
authors.initials: A
authors.lastname: Mammis
authors.forename: Daniel
authors.initials: D
authors.lastname: Yanni
authors.forename: Gaurav
authors.initials: G
authors.lastname: Gupta
authors.forename: Reza
authors.initials: R
authors.lastname: Karimi
authors.forename: Michael
authors.initials: M
authors.lastname: Schulder
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005153:Facial Neoplasms / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D007765:Lacrimal Apparatus / Q000601:surgery; D008297:Male; D011007:Pneumocephalus / Q000628:therapy*; D011183:Postoperative Complications / Q000628:therapy*