Transnasal Endoscopic Treatment of Tension Pneumocephalus Caused by Posttraumatic or Iatrogenic Ethmoidal Damage

Figure 1

(a) Anterior skull base defect exposure; (b) enlargement of the breach to remove valve action and sharp edges; (c) cauterizing small bleeding vessels surrounding the bone rupture; (d–f) instillation of warmed normal saline. Note that the air bubble blowing out: (g) sealing the defect with a thigh fat plug, (h) fascia lata insertion, and (i) modified Hadad flap.