Improvised Neurosurgical Intervention for Tension Pneumocephalus in a Resource-Limited Setting

Introduction Tension pneumocephalus is a life-threatening neurosurgical emergency requiring prompt decompression and repair of the underlying dural defect. Management may be challenging in resource-limited settings where specialised neurosurgical equipment is unavailable. Case description We report a 30-year-old male who developed progressive headache, dizziness, vomiting, and clear otorrhea one day after a motor vehicle crash. Computed tomography demonstrated extensive intracranial air with the Mount Fuji sign and a left zygomatic bone fracture. Bifrontal craniotomy was performed using conventional surgical instruments, including a Hudson brace and Gigli saw. An anterior skull-base dural defect beneath the left frontal lobe was identified and repaired using a vascularised pericranial graft. The frontal sinus was obliterated, the bone flap replaced and secured with sutures, and a drain inserted. Postoperatively, the patient improved clinically, with resolution of otorrhea. Follow-up computed tomography at two weeks demonstrated resolution of tension pneumocephalus, with a small epidural seroma managed conservatively. At one-month follow-up, he remained clinically stable without further reported complications. Discussion This case highlights the importance of early recognition and definitive surgical management of tension pneumocephalus. Conventional instruments and autologous pericranium may facilitate essential surgical repair when specialised equipment is unavailable, provided appropriate expertise and perioperative support are available.