Intraoperative Development of Tension Pneumocephalus in a Patient Undergoing Repair of a Cranial‑dural Defect Under Nitrous Oxide Anesthesia

Rapid buildup of gas within the cranial vault can result in alife-threatening condition known as “tension pneumocephalus,” necessitating immediate surgical intervention. Nitrous oxide (N O), a commonly used inhaled anesthetic, is associated with the development of tension pneumocephalus and its role in neurosurgical procedures has been debated in the literature. We present a case of tension pneumocephalus with preexisting pneumocephalus secondary to the usage of N O as an inhaled anesthetic. Included is a literature review of studies discussing the role of N O in the development of tension pneumocephalus. N O is associated with tension pneumocephalus especially in the setting of preexisting pneumocephalus. Tension pneumocephalus can manifest as Cushing response and immediate decompression is life-saving. Nitrous oxide should be used cautiously in neurosurgical procedures, especially with preexisting pneumocephalus.