title: Tension pneumocephalus secondary to osteoradionecrosis of the clivus.
abstract: We report the case of a 36 year-old man with relapsing undifferentiated nasopharyngeal carcinoma treated with a re-irradiation Cyberknife, who subsequently developed tension pneumocephalus due to a cerebrospinal fluid leakage located at the clivus. The fistula was caused by osteonecrosis of the skull base secondary to the tumor invasion and to the sequelae of the radiotherapy. An endoscopic endonasal technique was used in order to repair the defect, with a peduncolated nasoseptal flap harvested to perform the skull base reconstruction. In this paper, we discuss the importance of identifying this possible complication related to radiotherapy in the management of neoplasm along the skull base; moreover, the role of endoscopy in the diagnosis and treatment of skull base fistulas is also described and commented.
authors.affiliation: Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Risso
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Zoia
authors.affiliation: Department of Otorhinolaryngology, Ospedale San Antonio Abate, Via Cosenza 82, 91016 Erice, Trapani, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Gianformaggio
authors.affiliation: Department of Otorhinolaryngology, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.affiliation: Department of Otorhinolaryngology, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.affiliation: Department of Otorhinolaryngology, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benazzo
authors.affiliation: Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, Piazzale Golgi 19, 27100 Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gaetani
keywords: Endoscopic endonasal approach; Nasopharyngeal carcinoma (NPC); Skull-base fistula; Tension pneumocephalus (TP)