Compressive pneumocephalus is a rare condition, most often secondary to head trauma or surgery. We report post-operative
compressive pneumocephalus in a patient who underwent primary surgery for anterior clinoid meningioma complicated by CSF
leakage treated by lumbar spinal drainage. CT scan clearly demonstrates a compressive pneumocephalus with the sign of the Mount
Fuji. The patient was treated with definite bed rest and plenty of fluid replacement with good outcome. Compressive pneumocephalus
is a serious, infrequent complication and a possible cause of postoperative worsening. Medical treatment combining highly inspired
oxygen therapy and rehydration are sufficient to correct the condition.
Mr. A.H, 69 y old women, with a history of mitral valve disease,
admitted in our department for a meningioma of the anterior
clinoid process revealed by facial neuralgia in the territory of V1
evolving for 5 years and becoming resistant to medical treatment
with carbamazepine. The clinical assessment of the patient at his
admission showed a conscious patient with a Glasgow coma score
(GCS) of 15, without neurological deficit or visual trouble.
Figure 1: Cerebral MRI sagittal weighted T1 contrast (a), and coronal T2 showing anterior clinoid process meningioma with
homogeneous enhancement (a) and hyperintense T2 (b).
The cerebral MRI showed a sellar lesion inserted on the
anterior clinoid process in hypo signal T1, hypersignal T2 with
homogenous enhancement after gadolinium injection suggesting
meningioma (Figure 1). Gross total removal “Simpson I” by left
pterional approach was performed and the histopathological exam
confirmed transitional meningioma. The post-operative course
was marked by the anterior left and posterior rhinorrhea as well
as meningitis, treated successfully by antibiotics with lumbar
spinal drainage. However, 3 days later, the patient accidentally fell
from her bed causing a CSF hyper drainage bringing back more
than 800CC, accusing excruciating headaches and disturbances
of consciousness (GCS =12) without neurological deficit. CT scan
showed a huge compressive bifrontal pneumocephalus with the
Mount Fuji sign (Figure 2). The decision made is to treat the patient
using a rehydration regimen with daily control by an ionogram, bed
rest, plenty of fluid replacement and clamping the spinal drainage.
The outcome was favorable with a return to a clear consciousness
without rhinorrhea or neurological deficit, also with a good control
of brain CT (Figure 3).
Figure 2: Axial brain CT scan with contrast demonstrating a huge compressive pneumocephalus with Mount Funji sign.
Figure 3: Axial cerebral CT scan showing regression of pneumocephalus after 1 week of treatment (a), and after 1 month (b).