Post traumatic pneumocephalus, its complications and management outcome: A prospective study in tertiary care center

Abstract

To study clinical course and complications in patients diagnosed to have post-traumatic pneumocephalus based on: 1. Patterns of associated skull fractures; 2 Findings seen in CT scan which may be risk factors for development of CSFR, meningitis or tension pneumocephalus. To study clinical outcome in patients with PTP This prospective observational study was conducted over a period of 14 months from 15 Nov. 2017 to 15 Jan. 2019 in Goa Medical College, a tertiary care centre for the management of all kind of trauma patients including TBI. The study included all cases of TBI with CT head showing PTP alonwith there radiological findings, clinical course, complications and its management outcome. A total of 102 cases of post-traumatic pneumocephalus were included in the study. Motor vehicle accident was found to be major cause of PTP (79.41%). The most common site of post traumatic PTP was subdural (45.1%). Majority of the patients with PTP had focal PTP underlying the fracture segment (63.73%). Majority of the patients (30) had either isolated fracture frontal sinus (18) or multiple basal (12). CSFR was seen in 13 patients. Majority (74.51%) of patients were treated conservatively. Most of operative interventions were done for associated EDH, SDH, Contusion or diffuse brain injuries. Comminuted depressed fracture frontal sinus is most common fracture associated in patients with massive pneumocephalus and CSFR. All patients with evidence of post traumatic PTP and basal skull fracture must be followed over longer period as delayed onset TP, CSF leak and meningitis didn’t show any specific pattern with initial presentation.The use of prophylactic anticonvulsants should be based on the presence of other indications for it.Patients with PTP can be managed without prophylactic antibiotics which can be reserved then only for those with contaminated injuries.TP, CSF leak and meningitis are life threatening complications of PTP. Early recognition and high index of clinical suspicion and prompt treatment results in improvement of vast majority of patients.