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106 Section II: Intracranial Procedures

A B

C

D

Figure 10.18 An 8‐year‐old male Golden Retriever presented with a history of generalized seizures for 2 months. The images in (B) and (C) were obtained
20 days after the surgery, when he was presented for neck pain and depression. (A) Dorsal T1‐weighted postgadolinium MRI of the brain before surgery.
There is evidence of a mass affecting the left olfactory and frontal lobe. This mass shows homogeneous contrast enhancement and a dural tail sign associated
with the longitudinal fissure. (B) Sagittal T2‐weighted MRI of the brain. There is signal void in the lateral, third and fourth ventricles. There is also signal
void in the subarachnoid space of the cervical spine. These images are consistent with pneumocephalus and pneumorrhachis. (C) Transverse T2‐weighted
FLAIR image of the brain at the level of the frontal lobe. There is signal void in the dorsal aspect of the left frontal lobe. This might represent the fistula.
(D) Sheets of cells with indistinct cell borders, elongate to ovoid nuclei, and mostly one prominent nucleolus, consistent with a transitional meningioma.
H&E staining, ×40. Source: (D) Courtesy of Dr. Jim Cooley.

of pneumocephalus into tension pneumocephalus (symptomatic appreciate that in the cases of hypertensive pneumocephalus and CSF
intracranial air) is a rare phenomenon and has been rarely described leakage described, no attempt to close the dural defect was made.
in veterinary medicine [20,27–30]. Damage of the cribriform plate Clinical signs of hypertensive pneumocephalus are nonspecific
seems the most common reason [27–29]. Transfrontal cranioto­ and consistent with a diffuse anatomical localization. Depression,
mies can result in a large postoperative dural defect. Moreover, dis­ pain, seizures, and abnormal behavior are classically described [27–29].
ruption of the cribriform plate and ethmoturbinates results in This clinical presentation is similar to meningoencephalitis, which
increased exposure of the surgical site. This might explain the high is also a possible postsurgical complication. The diagnosis can only
risk of tension pneumocephalus in humans following transfrontal be made after diagnostic imaging evaluation and CSF analysis. In
craniotomies. Repair of the dural defect is not considered essential with the particular case of ventricular pneumocephalus, evaluation of
the transfrontal approach. However, reviewing the literature, we can skull radiographs may show radiolucent areas corresponding to the