Spontaneous Intraventricular Tension Pneumocephalus: Case Report and Review of the Literature

Intracranial pneumocephalus is a well-known clinical entity most frequently caused by trauma and intracranial surgery. A less frequent cause of intracranial pneumocephalus is spontaneous pneumocephalus. Spontaneous pneumocephalus can have an intraventricular extension, causing tension intraventricular pneumocephalus. We present an exceptionally rare case of spontaneous otogenic intraventricular pneumocephalus in a 58-year-old female that resulted in a decline in mentation and neurologic deficit. The patient was subsequently treated with ventriculostomy and middle fossa craniotomy, with repair of a bony defect and dural closure. This case demonstrates an unusual presentation of spontaneous intraventricular tension pneumocephalus necessitating ventriculostomy in addition to the traditional repair of a cerebrospinal fluid fistula. •A temporal bone defect with an encephalocele produces intradural pneumocephalus.•A ball-valve mechanism possibly led to tension intraventricular pneumocephalus.•Tension intraventricular pneumocephalus may lead to a comatose state.•An external ventricular drain may treat tension intraventricular pneumocephalus.