Two Cases of Tension Pneumocephalus after Endonasal Skull Base Surgery and Vestibular Schwannoma Surgery

Pneumocephalus, the presence of air in the cranial cavity, is a rare but serious complication of both head trauma and post-neurosurgery procedures.Tension pneumocephalus, marked by significant air accumulation causing mass effect and neurological symptoms, is even more uncommon and demands prompt intervention.The authors report two cases of tension pneumocephalus.The first case involved a 52-year man who experienced a rapid loss of consciousness after endonasal skull base surgery.Decompressive craniectomy was performed, and the patient recovered with conservative management.The second case was a 41-year woman who developed tension pneumocephalus within an hour after vestibular schwannoma surgery, leading to loss of consciousness and cerebral infarction.Despite conservative treatment, her condition worsened, and care was withdrawn after three weeks without improvement.The Mount Fuji sign on CT is a key indicator of tension pneumocephalus.Urgent neurosurgical intervention, such as trephination or burr hole craniotomy, is critical to relieve pressure and prevent further neurological damage.Needle aspiration and ventriculostomy are additional treatment options.Anaesthetic management should focus on avoiding nitrous oxide, maintaining cerebral perfusion, and controlling airway pressures.These cases highlight the need for vigilance in identifying tension pneumocephalus and initiating timely treatment to optimise patient outcomes.