Management and Treatment of Delayed Posttraumatic Tension Pneumoventricle in Low-Income Countries: A Report of Two Rare Cases and Literature Review

The tension pneumoventricle is a rare subtype of pneumocephalus characterized by intracranial hypertension secondary to pathological accumulation of air in the cerebral ventricles. This rare neurosurgical emergency has a life-threatening course. A delayed posttraumatic tension pneumoventriculus is an extremely rare condition that appears 72 h after head trauma. It can occur following a skull base fracture complicated by an osteodural defect without pneumocephalus or, more rarely, as a complication of simple acute posttraumatic pneumoventricle. This pathology represents a challenge in low-income countries because of limited access to social security and brain imaging and an inefficient health transport system. Its diagnosis and treatment may require multiple brain computed tomography scans in the acute phase of trauma and rapid medical evacuation. Here we report two patients with skull base fractures whose state of consciousness deteriorated after they returned home due to delayed posttraumatic tension pneumoventricle. The patients were rapidly taken to the hospital and treated in the emergency department, and their outcome was generally favorable. These cases underline the importance of regular, high-quality follow-up for skull base trauma patients in low-income countries, even after discharge from the hospital.