Delayed pneumocephalus following craniofacial trauma in a child: successful management with combined endoscopic endonasal and external osteoplastic skull base repair.

INTRODUCTION

Delayed pneumocephalus is exceptionally rare in children and may result from unrecognized skull base fractures with cerebrospinal fluid (CSF) leak. Prompt recognition is essential to prevent life-threatening complications.

CASE PRESENTATION: A 13-year-old boy developed delayed pneumocephalus and meningoencephalocele after high-impact facial trauma with multifocal skull base defects (posterior frontal sinus wall, sphenoid, and anterior ethmoid). He underwent combined endoscopic endonasal and external osteoplastic repair with multilayer closure and a temporary lumbar drain. Recovery was uneventful with complete clinical and radiological resolution within four months.

DISCUSSION: In the absence of pediatric-specific guidelines, management is often extrapolated from adult algorithms that favor a short conservative trial followed by CSF diversion or surgery for persistent leaks or high-risk features. In multifocal, complex defects, a hybrid endoscopic-osteoplastic strategy can provide precise localization and secure multilayer closure, and adjunctive lumbar drainage has been shown to further improve repair success.

CONCLUSION

Clinicians should suspect delayed pneumocephalus when new neurological or rhinologic symptoms arise after pediatric craniofacial trauma. A combined endoscopic-osteoplastic approach is a safe and effective option for complex skull base defects in children.