• Adam Tucker, Hiroji Miyake, Masao Tsuji, Tohru Ukita, Kentaro Nishihara, Seiko Ito, and Takehisa Ohmura.
• Department of Neurological Surgery, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan. tucker@nk-hospital.or.jp
• Neurol. Med. Chir. (Tokyo). 2008 Oct 1;48(10):474-8.

AbstractA 20-year-old male presented with an extremely rare spontaneous epidural pneumocephalus which was successfully treated by a single neurosurgical intervention. The patient had a habit of nose blowing and a 1-year history of progressive headache and nausea. Cranial computed tomography (CT) revealed a 2 x 7 cm right temporo-occipital epidural pneumocephalus with extensive hyperpneumatization of the mastoid cells. Right temporo-occipital craniotomy with a right superficial temporal artery and vein flap repair resulted in radiographic resolution of the pneumocephalus, and he remained neurologically free of symptoms at 1-year follow-up examination. Early identification and monitoring of symptomatic pneumocephalus followed by decompression and prevention of infection via closure of the bone defect can avoid possible serious consequences. The underlying mechanisms may involve a congenital petrous bone defect and a ball-valve effect due to excessive nose blowing in our case.

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