Tegmen dehiscence precipitated by barotrauma in idiopathic intracranial hypertension

Attenuation of the tegmen has been associated with increased intracranial pressure (ICP) and increasingly observed in patients with idiopathic intracranial hypertension (IIH). Over time, the attenuated tegmen may be at increased risk for spontaneous dehiscence and result in cerebrospinal fluid (CSF) leakage. While spontaneous tegmen dehiscence has been reported in cases of elevated ICP, external etiologies (e.g., barotrauma) as potential precipitating factors remain understudied. We present the first two documented cases of tegmen dehiscence likely precipitated by barotrauma in patients with presumed IIH. Early recognition of barotrauma-induced tegmen rupture can be critical for preventing complications such as recurrent CSF leakage and infection (e.g., meningitis). Further research is needed to assess the progression of skull base attenuation in IIH and its susceptibility to barometric stressors.