Tension Pneumocephalus: Report of Two Cases

張力性氣腦：兩病例報告

岳德政(Te-Cheng Yueh) ； 洪恭誠(Kuang-Chen Hung) ； 張迪生(Dyi-Sheng Chang)

《Formosan Journal of Surgery》 39卷1期 (2006/02) Pp. 38-42

https://doi.org/10.29833/FJS.200602.0007

摘要

張力性氣腦會造成神經功能快速惡化。我們報告兩位頭部外傷合併張力性氣腦的病人。第一位病患於兩年多前曾因嚴重的頭部外傷接受緊急開顱手術，之後發現左側肢體無力及小便失禁的症狀，腦部電腦斷層顯示腦內及腦室有空氣聚集，另一位則是頭部創傷後持續頭痛和腦脊髓液鼻漏，腦部電腦斷層顯示有大量空氣聚集在蛛網膜下，並且壓迫正常腦組織。
兩位病患接受緊急開顱手術治療，並分別利用人工硬腦膜及顯部肌肉皮瓣做腦膜修復。手術前的神經症狀於手術後逐漸恢復，術後追蹤的腦部電腦斷層也沒有發現空氣聚集於腦部。
當病人有顱骨骨折合併持續頭痛或意識改變時，臨床醫生須將張力性氣腦列入鑑別診斷。電腦斷層對於早期診斷張力性氣腦，是非常有效的檢查工具。

並列摘要

Tension pneumocephalus is the presence of intracranial air under pressure which can cause rapid neurological deterioration requiring emergency surgery. This is a report of two cases of intracranial tension pneumocephalus. The first patient had a history of emergent craniotomy due to a traumatic frontal depressed skull fracture with minimal pneumocephalus. He complained of progressive weakness in the left limbs and urinary incontinence 32 months after his head injury. A brain computed tomographic scan showed compressive pneumo-ventricle and pneumocephalus. The second patient complained of persistent headache and cerebrospinal fluid (CSF) rhinorrhea two weeks after a road traffic accident. The brain computed tomographic scan demonstrated a massive accumulation of air in the subarachnoid space of the cranial cavity having a compressive effect on the brain. The first patient underwent a pterional approach craniotomy and the dural defect was repaired with a dura substitute(Neuropatch). The second patient underwent a bicoronal craniotomy with temporal muscle fascia graft packing. The clinical symptoms of both patients improved after the operations without neurological deficits. The diagnosis of pneumocephalus is made according to clinical signs and the presence of intracranial air shown in the brain computed tomographic scan. The main cause of failure of this treatment is the lack of repair of the dural tear. Medical practitioners should always keep in mind the possibility of tension pneumocephalus when patients having skull fractures complain of headaches and neurological deterioration. Brain computed tomography is an effective tool in the early diagnosis of tension pneumocephalus.

並列關鍵字

brain injury ； cerebrospinal fluid leak ； tension pneumocephalus