title: Lessons in the management of post-operative tension pneumocephalus complicating transcranial resection of advanced cutaneous tumours with free flap reconstruction.
abstract: Tension pneumocephalus is a rare, but potentially life-threatening complication of transcranial surgery. Whilst commonly described in the field of neurosurgery, little has been published in the context of craniofacial surgery. We describe two cases of post-operative extradural tension pneumocephalus occurring following free myocutaneous latissimus dorsi flap reconstruction of anterior cranial defects following extirpation of advanced recurrent skin carcinomas. These cases illustrate the variation in clinical presentation of this condition, the importance of prompt recognition, urgent radiological investigation and timely decompression, and potential management strategies for minimising the risk of recurrent symptoms.
authors.affiliation: Oxford Craniofacial Unit (Head: Mr. Steven A. Wall), West Wing, Oxford University Hospitals NHS Trust, Headington, Oxford OX3 9DU, United Kingdom. Electronic address: marc.swan@nds.ox.ac.uk.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Swan
authors.forename: Anna F M
authors.initials: AF
authors.lastname: Scholz
authors.forename: Pieter M
authors.initials: PM
authors.lastname: Pretorius
authors.forename: David
authors.initials: D
authors.lastname: Johnson
authors.forename: Pablo
authors.initials: P
authors.lastname: Martinez-Devesa
authors.forename: Steven A
authors.initials: SA
authors.lastname: Wall
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D004388:Dura Mater / Q000601:surgery; D005153:Facial Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000637:transplantation; D005626:Frontal Sinus / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000009:adverse effects* / Q000637:transplantation; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009918:Orbital Neoplasms / Q000601:surgery; D010255:Paranasal Sinus Neoplasms / Q000601:surgery*; D011007:Pneumocephalus / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D015641:Radiography, Interventional; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012008:Recurrence; D012878:Skin Neoplasms / Q000601:surgery*; D013396:Suction / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Complication; Free flap reconstruction; Tension pneumocephalus; Tension pneumocranium; Transcranial surgery