In the present day of antenatal screening, ultrasound, amniocentesis and folate therapy, we still are unfortunate to see babies with open neural tube defects being born occasionally. We saw a 2150 grams girl who was born caesarian section at 35 weeks gestation. An open leaking myelomeningo-cele was observed on her lumbo- sacral area. Both lower extremities were paralytic. Other systemic examinations were normal. A cranial ultrasonography showed dilated both lateral ventricles and hyperechoic materials in frontal horns of lateral ventricle, which suggested air. A cranial computerized tomography (CT) scan revealed apparent hydrocephalus and pneumocephalus on lateral ventricles. A considerable brain edema was also present (Fig. 1). Staphylococcus aureus was grown in blood and CSF cutlure. Teicoplanine (10 mg/kg/d) and amikacin (15 mg/kg/d) were started intra-venously for the treatment of meningitis and sepsis. The patient died at the 14th day of therapy.

Fig. 1. Nonenhanced Cranial CT Scan shows Prominent air (pneumocephalus) in the frontal horns of lateral ventricles and left sylvian fissure.

Pneumocephalus (pneumocranium) means air in cranium. It is associated with several neurosurgical procedures, lumbar puncture, or cranial trauma and rarely with open neural tube defects(1). Spontaneous pneumocephalus has been previously reported in four cases(2-5) in babies with hydro-cephalus and open sacral myelomeningocele.

An X-ray film, cranial ultrasound or CT scan can detect pneumocephalus. Cranial ultrasonography can pickup smaller amounts of air than conventional X-rays.

Massive pneumocephalus can increase the intracranial pressure and behave as life threatening condition. Drainage of air by a needle or a subdural drain may be performed(1). We performed transencephalic puncture for three times for meningitis and drainage of pneumocephalus.

Myelomeningocele is usually complicated with intracranial infections such as meningitis and ventriculitis. Spontaneous pneumo-cephalus should be kept in mind as a rare complication of open meningomyelocele. Any patient with open meningomyelocele should be carefully evaluated for pneumo-cephalus with a cranial USG. This infor-mation is useful prognostically as well as has therapeutic implications.

Ender Ödemis,
Yakup Aslan,
Department of Pediatrics,
Karadeniz Technical University,
61080 Trabzon,
Turkey.
E-mail: [email protected]

1. Sawka AM, Aniszewski JP, Young WF Jr. Nippoldt TB, Yanez P, Ebersold MJ. Tension pneumocranium, a rare complication of transsphenoidal pituitary surgery: Mayo Clinic experience 1976-1998. J Clin Endocrinol Metabol 1999; 84: 4731-4734.

2. Garonzik IM, Samdani AF, Carson BS, Avellino AM. Pneumocephalus in a newborn with an open myelomeningocele. Pediatr Neurosurg 2001; 35: 334.

3. Kao SC, Brown BP, Goedken J. Sonography of intracranial air in a newborn with meningo-myelocele. Pediatr Radiol 1991; 21: 375-376.

4. Pampaloni A, Vichi GF, Ienuso R, Danti DA, Maggini M, Grisolia GA. Spontaneous pneu-mocephalus in a newborn infant. Presentation of 1 case. Rev Neurobiol 1981; 27: 543- 548.

5. Trawoger R, Strasser K, Ellenmunter H, Gassner I. Spontaneous pneumocephalus in a newborn infant with myelomeningocele and hydromyelia. Dev Med Child Neurol 1994; 36: 924-927.