Abstract：
BACKGROUND: Cerebrospinal fluid (CSF) leak through petrosal air cells is a known complication after drilling the posterior wall of the internal acoustic canal (IAC) for resection of vestibular schwannoma (VS). Whereas mild pneumocephalus is common after retrosigmoid craniotomy, tension pneumocephalus has been rarely documented.
OBJECTIVE: To testify a case of fatal tension pneumocephalus after VS resection in a patient with ventriculo-peritoneal (VP) shunt and to propose possible recommendations to limit the risk of this dramatic complication.
METHODS: A case of fatal tension pneumocephalus after VS resection in presence of hidden CSF fistula is illustrated with pre- and post-operative images.
RESULTS: In the uneventful situation of concomitant post-operative CSF fistula in presence of VP shunt, tension pneumocephalus may occur. The negative pressure created by the shunt system and the presence of osteo-dural defect allow the air to enter and, at the same time, prevent the outflow.
CONCLUSIONS: After VS resection, tension pneumocephalus can occur as a consequence of CSF fistula from petrosal air cells in the presence of functioning VP shunt. Precautions as pre-operative increase to \'virtual-off\' the pressure of the valve, subsequences CT scans after surgery and sealing of the petrous air cells are recommended to avoid such as fatal complication.
OBJECTIVE: To testify a case of fatal tension pneumocephalus after VS resection in a patient with ventriculo-peritoneal (VP) shunt and to propose possible recommendations to limit the risk of this dramatic complication.
METHODS: A case of fatal tension pneumocephalus after VS resection in presence of hidden CSF fistula is illustrated with pre- and post-operative images.
RESULTS: In the uneventful situation of concomitant post-operative CSF fistula in presence of VP shunt, tension pneumocephalus may occur. The negative pressure created by the shunt system and the presence of osteo-dural defect allow the air to enter and, at the same time, prevent the outflow.
CONCLUSIONS: After VS resection, tension pneumocephalus can occur as a consequence of CSF fistula from petrosal air cells in the presence of functioning VP shunt. Precautions as pre-operative increase to \'virtual-off\' the pressure of the valve, subsequences CT scans after surgery and sealing of the petrous air cells are recommended to avoid such as fatal complication.
摘要：
背景：脑脊液（CSF）通过岩层空气细胞泄漏是在内声管（IAC）后壁钻孔切除前庭神经鞘瘤（VS）后的一种已知并发症。而乙状结肠后颅开颅手术后常见轻度气颅，张力性气颅很少被记录。
目的：为了证明一例脑室-腹膜（VP）分流患者经VS切除后发生致命的张力性气颅，并提出可能的建议以限制这种严重并发症的风险。
方法：通过术前和术后图像说明了一例VS切除术后存在隐藏的CSF瘘的致命张力性气颅。
结果：在并发有VP分流的术后CSF瘘的情况下，可能会发生张力性气颅。分流系统产生的负压和硬脑膜缺损的存在使空气进入，同时,防止外流。
结论：VS切除后，在存在功能正常的VP分流的情况下，由于来自岩石空气细胞的CSF瘘，可能会发生张力性气颅。操作前的预防措施将阀门压力增加到“虚拟关闭”，建议在手术后进行CT扫描并密封岩层空气细胞以避免致命并发症。
目的：为了证明一例脑室-腹膜（VP）分流患者经VS切除后发生致命的张力性气颅，并提出可能的建议以限制这种严重并发症的风险。
方法：通过术前和术后图像说明了一例VS切除术后存在隐藏的CSF瘘的致命张力性气颅。
结果：在并发有VP分流的术后CSF瘘的情况下，可能会发生张力性气颅。分流系统产生的负压和硬脑膜缺损的存在使空气进入，同时,防止外流。
结论：VS切除后，在存在功能正常的VP分流的情况下，由于来自岩石空气细胞的CSF瘘，可能会发生张力性气颅。操作前的预防措施将阀门压力增加到“虚拟关闭”，建议在手术后进行CT扫描并密封岩层空气细胞以避免致命并发症。
