Bulging Scalp in a Patient With Postoperative Tension Pneumocephalus

A patient who underwent neurosurgery 1 month prior for a head injury (a compound, depressed, comminuted right frontal bone fracture involving the frontal sinus with underlying contusion and subdural pneumocephalus) presented with abnormal bulging of his scalp at the external site of the repair made worse with Valsalva maneuver.

The bulging was caused by incomplete frontal sinus obliteration during injury repair, with a residual communication between the frontal sinus and frontal lobe parenchyma causing pneumocephalus and air leak with Valsalva maneuver through a titanium mesh repair.

The patient underwent frontal sinus re-obliteration with placement of a vascularized pericranial flap. The bulging completely disappeared, and the patient made an uneventful recovery.

Click the Related Article link for images of the injury, pneumocephalus, and complete case details.