{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:29:42Z","timestamp":1769725782719,"version":"3.49.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Spontaneous pneumocephalus is a rare, but potentially serious condition often secondary to a CSF leak. This egress of CSF causes an inward movement of air to replace the lost volume. CSF leaks are typically posttraumatic and present as rhinorrhea or otorrhea. Locating the bony defect and herniating contents through imaging is crucial for planned surgical intervention. In this report, the author present the case of a patient with progressive spontaneous pneumocephalus with an apparent but unidentifiable CSF leak.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 76-year-old female presented to the authors\u2019 institution with rapidly progressing spontaneous pneumocephalus. This case is unique in that the patient\u2019s pneumocephalus continued to expand without any radiological indication of extracranial CSF, leading us to believe that the CSF was intermittently leaking through the eustachian tube and passing down the patient\u2019s oropharynx. Given the presumed pathway, an initial conservative surgical approach was chosen for this patient\u2019s spontaneous pneumocephalus instead of the traditional middle cranial fossa or transmastoid approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>To repair the leak, the authors attempted a more conservative approach involving closure of the external acoustic meatus and obliteration of the eustachian tube. A few studies using a similar procedure reported a lower risk of complications and reduction in postoperative CSF leaks.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE24834\">https:\/\/thejns.org\/doi\/10.3171\/CASE24834<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case24834","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T06:35:53Z","timestamp":1754289353000},"source":"Crossref","is-referenced-by-count":0,"title":["Life-threatening pneumocephalus from middle ear defect causing cerebrospinal fluid leakage into the eustachian tube: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8567-9242","authenticated-orcid":true,"given":"Hailey","family":"Mattheisen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6881-5139","authenticated-orcid":true,"given":"Abigail","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Laing","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan T.","family":"Zwagerman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Cheok","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin and Froedtert Hospital, Wauwatosa, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"bib1","series-title":"Radiol Case Rep","first-page":"1829","article-title":"Spontaneous pneumocephalus secondary to a cerebrospinal fluid fistula demonstrated by CT cisternography","volume":"15","author":"Van Liedekerke","year":"2020","unstructured":"Van Liedekerke LSanoussi S.Spontaneous pneumocephalus secondary to a cerebrospinal fluid fistula demonstrated by CT cisternography. Radiol Case Rep. 2020;15(10):1829-1831."},{"issue":"2","key":"bib2","series-title":"BJR Case Rep","first-page":"20150127","article-title":"Tension pneumocephalus: the neurosurgical emergency equivalent of tension pneumothorax","volume":"2","author":"Harvey","year":"2016","unstructured":"Harvey JJHarvey SCBelli A.Tension pneumocephalus: the neurosurgical emergency equivalent of tension pneumothorax. BJR Case Rep. 2016;2(2):20150127."},{"issue":"3","key":"bib3","series-title":"Radiol Case Rep","first-page":"365","article-title":"Tension pneumocephalus\u2014a rare complication of cerebrospinal fluid leak","volume":"14","author":"Healy","year":"2019","unstructured":"Healy JGrant MMelnyk SBoldt B.Tension pneumocephalus\u2014a rare complication of cerebrospinal fluid leak. Radiol Case Rep. 2019;14(3):365-367."},{"issue":"2","key":"bib4","series-title":"Acta Neurochir (Wien)","first-page":"361","article-title":"Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury","volume":"161","author":"Gorissen","year":"2019","unstructured":"Gorissen ZHakvoort Kvan den Boogaart MKlinkenberg SSchijns O.Pneumocephalus: a rare and life-threatening, but reversible, complication after penetrating lumbar injury. Acta Neurochir (Wien). 2019;161(2):361-365."},{"issue":"4","key":"bib5","series-title":"Indian J Radiol Imaging","first-page":"441","article-title":"Imaging review of cerebrospinal fluid leaks","volume":"27","author":"Vemuri","year":"2017","unstructured":"Vemuri NVKaranam LSPManchikanti VDandamudi SPuvvada SKVemuri VK.Imaging review of cerebrospinal fluid leaks. Indian J Radiol Imaging. 2017;27(4):441-446."},{"issue":"186","key":"bib6","article-title":"Middle fossa approach to repair cerebrospinal fluid leak","volume":"2024","author":"Cunningham","year":"2024","unstructured":"Cunningham CDIIIPark BBrown CS.Middle fossa approach to repair cerebrospinal fluid leak. J Med Insight. 2024;2024(186)."},{"issue":"1","key":"bib7","series-title":"J Neurol Surg B Skull Base","first-page":"71","article-title":"Spontaneous cerebrospinal fluid leak through the posterior aspect of the petrous bone","volume":"73","author":"Nadaraja","year":"2012","unstructured":"Nadaraja GSMonfared AJackler RK.Spontaneous cerebrospinal fluid leak through the posterior aspect of the petrous bone. J Neurol Surg B Skull Base. 2012;73(1):71-75."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"155","article-title":"Review of the management of pneumocephalus","volume":"6","author":"Dabdoub","year":"2015","unstructured":"Dabdoub CBSalas GSilveira NDabdoub CF.Review of the management of pneumocephalus. Surg Neurol Int. 2015;6:155."},{"issue":"5","key":"bib9","series-title":"Laryngoscope Investig Otolaryngol","first-page":"215","article-title":"Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review","volume":"2","author":"Lobo","year":"2017","unstructured":"Lobo BCBaumanis MMNelson RF.Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol. 2017;2(5):215-224."},{"issue":"6","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE21590","article-title":"Endoscopic closure of the Eustachian tube orifice for refractory lateral skull base cerebrospinal fluid leak using autologous fat graft: illustrative case","volume":"3","author":"Mehta","year":"2022","unstructured":"Mehta GUFatima NLekovic GPSlattery WH.Endoscopic closure of the Eustachian tube orifice for refractory lateral skull base cerebrospinal fluid leak using autologous fat graft: illustrative case. 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J Med Insight. 2024;2024(186)."},{"issue":"1","key":"bib7","series-title":"J Neurol Surg B Skull Base","first-page":"71","article-title":"Spontaneous cerebrospinal fluid leak through the posterior aspect of the petrous bone","volume":"73","author":"Nadaraja","year":"2012","unstructured":"Nadaraja GSMonfared AJackler RK.Spontaneous cerebrospinal fluid leak through the posterior aspect of the petrous bone. J Neurol Surg B Skull Base. 2012;73(1):71-75."},{"key":"bib8","series-title":"Surg Neurol Int","first-page":"155","article-title":"Review of the management of pneumocephalus","volume":"6","author":"Dabdoub","year":"2015","unstructured":"Dabdoub CBSalas GSilveira NDabdoub CF.Review of the management of pneumocephalus. 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