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Endonasal endoscopic repair of posttraumatic tension pneumocephalus - case presentation and systematic review of the literature
EANS Academy. Röthlisberger M. 09/25/19; 275389; EP05033
Dr. Michel Röthlisberger
Dr. Michel Röthlisberger

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Abstract
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Background: Information about the endonasal endoscopic approach (EEA) for the management of posttraumatic tension pneumocephalus (PTTP) remains scarce. Data on time course and resolution rate of the intracranial air is lacking for this treatment modality. Concomitant cerebrospinal fluid (CSF)-leakage and posttraumatic hydrocephalus (PTH) can complicate the clinical course.
Methods: The authors describe their experience with an EEA to resolve a recurrent PTTP. They further systematically reviewed pertinent articles retrieved by search in the PubMed/EMBASE database between 1961 and November 2018.
Results: Including the presented case, the authors accounted for seven cases of PTTP in five previously published articles. The onset and clinical presentation was variable. All cases had a proven defect in the anterior base of skull. Active CSF-leakage was present in four cases. One or several transcranial approaches were performed in six out of seven cases before EEA. Morbidity and mortality were related to trauma-associated infectious complications, two (29%) and one (14%) out of seven cases respectively. The PTTP resolved in all cases treated by EEA, with a success-rate of six out of seven (71%) after the first attempt. The mean complete radiological resolution time was 48 days (range 23-101 days) without any late recurrence.

  1 (present case) 2 (Ansari 2014) 3 (Husseini 2013) 4 (Clark 2010) 5 (Clark 2010) 6 (Sindwani 2008) 7 (Aferzon 2001)
n. of non resolutive transcranial approach 2 0 2 1 1 1 1
n. of EEA 2 1 3 1 1 1 2
complete radiological resolution of PTTP (months) 5 - 3 1,5 2 24 -
Morbidity no no CSF shunt infection and pneumonia nosocomial pneumonia and septicemia no no no
Mortality no no no septicemia no no no
[Data]


Conclusions: Symptomatic PTTP is a rare clinical scenario. The endoscopic repair of the conduits of air entrance might constitute a safe and efficient approach, especially if transcranial procedures fail. However, the strength of recommendation for EEA remains low based on the current review.
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