Iatrogenic tension pneumocephalus complication of osteoradionecrosis in the treatment of nasopharyngeal carcinoma. A case report and critical literature review

ABSTRACT

Nasopharyngeal carcinoma typically originates in the fossa of Rosenmüller within the mucosal epithelium directly underlying the lymphatic tissue, and commonly presents clinically with symptoms such as headache, dizziness, and rhinorrhea. In this case study, we describe a 61-year-old man diagnosed with nasopharyngeal carcinoma who underwent radiation therapy with a total dose of 50 Gy administered at a rate of 2 Gy per day, along with chemotherapy consisting of cisplatin at a dose of 100 mg/m². Surgical intervention was deemed unsuitable due to the size of the tumors. Five months later, the patient developed a tension pneumocephalus due to a clival fistula “corking effect,” which resulted in the infiltration of air bubbles into the brain and culminating in his death 2 weeks after admission to the intensive care unit.

RESUMO

O carcinoma nasofaríngeo normalmente se origina na fossa de Rosenmüller, dentro do epitélio da mucosa diretamente subjacente ao tecido linfático, e comumente se apresenta clinicamente com sintomas como dor de cabeça, tontura e rinorreia. Neste estudo de caso, descrevemos um homem de 61 anos com diagnóstico de carcinoma de nasofaringe que foi submetido à radioterapia com dose total de 50 Gy administrada a uma taxa de 2 Gy por dia, juntamente com quimioterapia composta por cisplatina na dose de 100 mg/m². A intervenção cirúrgica foi considerada inadequada devido ao tamanho dos tumores. Cinco meses depois, o paciente desenvolveu pneumoencéfalo hipertensivo devido a um “efeito rolha” de fístula clival, que resultou na infiltração de bolhas de ar no cérebro e culminou em sua morte 2 semanas após a admissão na unidade de terapia intensiva.

Keywords:

Nasopharyngeal carcinoma - Radiotherapy - Pneumocephalus - Osteoradionecrosis

Descritores:

Carcinoma nasofaringeal - Radioterapia - Pneumoencéfalo - Osteorradionecrose

Publication History

Received: 17 October 2023

Accepted: 21 March 2024

Article published online:
16 May 2024

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