Posterior fossa tension pneumocephalus (PFTP) is a very rare clinical entity--OFF few case reports available prove how rare. Five patients with PFTP are presented. All were operated on for posterior fossa lesions. One was operated on in the lateral position and the rest in a sitting position. All the patients had postoperative (early) neurological deterioration, and computed tomography (CT) scans revealed PFTP in the left cerebellopontine angle in one case and in the IV ventricle in the rest. Air was aspirated from the posterior fossa in one case. All the cases were electively ventilated for 48-72 h. All the patients had an immediate onset of progressive neurological recovery after early intervention and elective ventilation. One patient died 10 days later because of a recurrence of empyema and the development of meningitis. PFTP is a rare but important complication of posterior fossa surgery. Early intervention and elective ventilation can produce a good recovery.
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