Tension pneumatocele is a very rare but potentially fatal complication of transsphenoidal surgery that can result from an influx of air into the intracranial cavity through the cerebrospinal fluid fistula. Although transsphenoidal surgeries for pituitary adenomas are very commonly performed procedures, this complication is extremely rare. We report a case of tension pneumatocele after transsphenoidal resection of a pituitary macroadenoma. After a second endoscopic transsphenoidal procedure to remove the air and repair of the sella floor, visual acuity recovered dramatically. Tension pneumatocele is an uncommon but potentially lethal complication of transsphenoidal pituitary surgery, which can present anytime, even after years postoperatively. It is important for all skull base surgeons to be aware of this condition so that prompt treatment can be instituted.

UNASSIGNED: Delayed intracerebral tension pneumatocele (DITP) is an uncommon cause of raised intracranial pressure following trauma. However, it can cause herniation syndrome due to a sudden increase in intracranial pressure which requires emergent intervention. Pneumocephalus is a complication of head injury in 3.9%-9.7% of the cases. The accumulation of intracranial air can be acute (<72 h) or delayed (≥72 h).
UNASSIGNED: When intracranial air causes intracranial hypertension and has a mass effect with neurological deterioration, it is called tension pneumocephalus. In our case series, we demonstrated four cases of DITP in adult patients from January 2012 to January 2017 in the Department of Neurosurgery at R. N. T. Medical College and M. B. Hospital, Udaipur, Rajasthan.
UNASSIGNED: During this period, a total number of patients admitted of head injury are 1768 and hence, the incidence of DITP in our series is 0.226% which is very less as compared to previous literature. All patients are male; age ranging from 17 years to 55 years (mean age was 31.75 years). All patients have a history of head injury, and mode of injury had road traffic accidents. Glasgow Coma Score (GCS) at readmission were 12-13 (mean GCS 12.75). Duration of developed DITP 1 month to 2½ months (mean 1.375 months), all patients had gone to surgical intervention, and outcome assessed using Glasgow outcome score. All patients had a good outcome and average follow-up was 12.5 months.
UNASSIGNED: long term observation of patients with simple pneumocephalus following trauma is beneficial as there is an expected risk of developing delayed tension pneumocephalus which may manifest with raised intracranial pressure.

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