• Daniele Armocida, Alessandro Pesce, Alessandro Frati, Massimo Miscusi, Francesco Paglia, and Antonino Raco.
• A.U.O. "Sant'Andrea", Neurosurgery Division, NESMOS Department, Sapienza University, Rome, Italy; A.U.O. "Policlinico Umberto I", Neurosurgery Division, Human Neurosciences Department, Sapienza University, Rome, Italy. Electronic address: danielearmocida@yahoo.it.
• World Neurosurg. 2019 Feb 1; 122: 661-664.

BackgroundPneumocephalus is an uncommon and life-threatening neurologic condition. Air within the ventricular system of the brain is also known as pneumoventricle (PV). It requires emergency treatments to prevent catastrophic neurologic outcomes. Head injury is the most common cause of PV, but there are other well-recognized etiologies in case there is no clear radiological evidence of skull discontinuity.Case DescriptionAlthough this clinical entity has been well described in the literature, our report presents the unique feature of describing a purely ventricular pneumocephalus without evidence of skull base or cranial vault fracture. Therefore, this case presentation explores mysterious causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault.ConclusionsThe aim of the present paper is to report a case of post-traumatic PV without radiological signs of skull base or convexity fracture in a 72-year-old man, underlining the diagnostic and clinical features, and review the relevant literature.Copyright © 2018 Elsevier Inc. All rights reserved.

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