title: Intraventricular tension pneumocephalus after endoscopic skull base surgery.
abstract: OBJECTIVE
  Postoperative pneumocephalus is commonly observed after neurosurgical intracranial procedures and is usually of little consequence. Intraventricular tension pneumocephalus, however, is a rare complication and a neurosurgical emergency that requires immediate intervention. We describe the first case of intraventricular tension pneumocephalus that developed 1 week following an expanded endoscopic endonasal approach for resection of a suprasellar mass.
  
  
  METHODS
  A patient who underwent an endoscopic transplanum transtuberculum approach for resection of a suprasellar epidermoid tumor developed a sudden change in mental status, with imaging consistent with intraventricular tension pneumocephalus. Immediate endotracheal intubation and placement of an external ventricular drain prevented further deterioration. Endoscopic exploration of the skull base reconstruction revealed a one-way ball valve mechanism as the source of pneumocephalus. The skull base reconstruction was revised with autologous fascia lata and repositioning of the pedicled nasoseptal flap.
  
  
  CONCLUSIONS
  Intraventricular tension pneumocephalus is a rare neurosurgical emergency that may develop after endoscopic skull base surgery. Initial management includes endotracheal intubation and placement of an external ventricular drain to decompress the ventricles. Endoscopic exploration and revision of the skull base repair is imperative to obliterate the ball-valve fistula to prevent further entrapment of air.
authors: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States.
authors: Antonios
authors: A
authors: Mammis
authors: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States.
authors: Nitin
authors: N
authors: Agarwal
authors: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States.
authors: Jean Anderson
authors: JA
authors: Eloy
authors: Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey, United States.
authors: James K
authors: JK
authors: Liu
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D002552:Cerebral Ventricles / Q000473:pathology; D004322:Drainage; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000209:etiology; D009897:Optic Chiasm / Q000473:pathology; D010911:Pituitary Neoplasms / Q000601:surgery; D011007:Pneumocephalus / Q000209:etiology* / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome