Kankane Vivek Kumar, Gupta Tarun Kumar
Department of Neurosurgery, R. N. T. Medical College, Udaipur, Rajasthan, India.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1087-1095. doi: 10.4103/ajns.AJNS_226_17.
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).
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.
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.
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.
迟发性脑内张力性气囊肿（DITP）是创伤后颅内压升高的一种罕见原因。然而，它可因颅内压突然升高导致脑疝综合征，这需要紧急干预。气颅是3.9% - 9.7%的头部损伤病例的并发症。颅内积气可为急性（<72小时）或延迟性（≥72小时）。
当颅内积气导致颅内高压并产生具有神经功能恶化的占位效应时，称为张力性气颅。在我们的病例系列中，我们展示了2012年1月至2017年1月在拉贾斯坦邦乌代布尔市R.N.T.医学院和M.B.医院神经外科的4例成年DITP患者。
在此期间，共收治头部损伤患者1768例，因此我们系列中DITP的发生率为0.226%，与既往文献相比非常低。所有患者均为男性；年龄在17岁至55岁之间（平均年龄为31.75岁）。所有患者均有头部受伤史，损伤方式为道路交通事故。再次入院时格拉斯哥昏迷评分（GCS）为12 - 13分（平均GCS为12.75）。发生DITP的时间为1个月至2个半月（平均1.375个月），所有患者均接受了手术干预，并使用格拉斯哥预后评分评估预后。所有患者预后良好，平均随访时间为12.5个月。
创伤后单纯气颅患者进行长期观察是有益的，因为存在发生迟发性张力性气颅的预期风险，其可能表现为颅内压升高。
