Huang C F, Chou T Y, Chang C K
Department of Surgery, Veterans General Hospital, Taichung, Taiwan, Republic of China.
Gaoxiong Yi Xue Ke Xue Za Zhi. 1992 Feb;8(2):113-6.
An 18-year-old Chinese man, suffering from head injury in a motorcycle accident, with right traumatic frontal intracerebral hemorrhage and frontal bone fractures, underwent emergency craniotomy with evacuation of hematoma at a local out-patient clinic and three months later, he suffered from CSF rhinorrhea. Headache, nausea and vomiting developed a week prior to admission. Tension pneumocephalus was diagnosed by computed tomography (CT) scan and plain skull X-ray. The fistula tract of the ethmoid sinus was investigated by radioisotope albumin (RISA) cisternography. The patient subsequently underwent emergency craniotomy for decompression. During the operation, we found that the intracerebral pneumatocele in the right frontal lobe communicated with the ipsilateral ethmoidal sinus, through which extracranial air ingressed and CSF egressed. This pneumatocele was unroofed and the fistula was temponaded by pericranial muscles and the Gelfomas sealed by tissue glue. Finally duraplasty was performed. Follow-up CT scan revealed that pneumocephalus subsided and the patient was cured of CSF rhinorrhea on discharge. As a surgical emergency, tension pneumocephalus can be successfully treated only by early diagnosis and early treatment.
一名18岁中国男性，在一次摩托车事故中头部受伤，伴有右侧创伤性额叶脑内出血和额骨骨折，在当地门诊接受了紧急开颅血肿清除术，三个月后出现脑脊液鼻漏。入院前一周出现头痛、恶心和呕吐。通过计算机断层扫描（CT）和颅骨平片诊断为张力性气颅。通过放射性同位素白蛋白（RISA）脑池造影检查筛窦瘘管。患者随后接受了紧急开颅减压术。手术中，我们发现右侧额叶脑内气囊肿与同侧筛窦相通，颅外空气由此进入，脑脊液由此流出。打开该气囊肿，用颅周肌肉填塞瘘管，并用组织胶封闭明胶海绵。最后进行硬脑膜成形术。随访CT扫描显示气颅消退，患者出院时脑脊液鼻漏治愈。作为一种外科急症，张力性气颅只有通过早期诊断和早期治疗才能成功治愈。
