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Tension Pneumocephalus after Endoscopic Sinus Surgery

Nasal endoscopy revealed extensive intranasal crusting, but failed to show a bony defect in the roof of the ethmoid or a CSF fistula. A CT cistemogram demonstratedextravasation ofcontrast material from the subarachnoid space into the ethmoid sinuses suggestive of a CSF leak from a defect in the region of the cribriform plate (see Figure, B). The patient continued to experience fluctuating mental status. On the 10th hospital day, he underwent bifrontal craniotomy, repair of the CSF leak, and placement of a lumbar drain. Intraoperatively, several durallacerations near the cribriform plate, as well as a wide bony defect of the right cribriform plate, were noted. A pericranial flap from the frontal scalp was placed over the extensive frontal cranial fossa defect and the crista galli. The patient had an uncomplicated postoperative course with clearing of mental status changes and no evidence of a recurrent CSF leak. CASE REPORT