Spontaneous Pnemocephalus Associated With Defects on the Tegmen Mastoideum

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A 48-year-old woman with a 1-year history of mild headaches presented to our otolaryngology department. The headaches were continual and more pronounced on the left side, and occasionally increased after sneezing and nose blowing. The patient reported feeling as though “the air was going into her head.” She did not have a history of head trauma.
Physical examination and psychological assessment were unremarkable. Audiometric evaluation was normal. Computed tomography (CT) revealed a very well-pneumatized temporal bone and the presence of air in the left anterior and middle fossa. The patient was diagnosed with a tension pneumocephalus. A canal up mastoid obliteration was performed with closure of aditus ad antrum. During surgery, mucosal thickening in the mastoid air cells and absence of the tegmen mastoideum with preserved trabeculae of the mastoidal cells was found. Relaxation of the temporal lobe was observed following lysis of mucosa covering the tegmen mastoideum. No dural defect was detected. The mastoid cavity was obliterated using fibrin sealant patch, bone paste, and abdominal fat.
Postoperatively, the patient reported headache improvement with complete relief in 2 weeks. One month postoperatively, pure-tone thresholds and tympanometry were within normal limits. Three months after surgery, magnetic resonance imaging findings confirmed complete absorption of the air intracranially.

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