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| TEACHING IMAGES |
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| Year : 2015 | Volume
: 3
| Issue : 2 | Page : 352-353 |
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Tension pneumocephalus: Mount Fuji sign
Pulastya Sanyal1, Keerthiraj Bele2, Santosh Phajir Vishwanath Rai1
1 Department of Radiodiagnosis, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
2 Department of Neuroradiology, Kasturba Medical College, Manipal University, Mangaluru, Karnataka, India
| Date of Web Publication | 16-Dec-2015 |
Correspondence Address:
Santosh Phajir Vishwanath Rai
Department of Radiodiagnosis, Kasturba Medical College and Hospital, Manipal University, Mangaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.171948
A 13-year-old male was operated for a space occupying lesion in the brain. A noncontrast computed tomography scan done in the late postoperative period showed massive subdural air collection causing compression of bilateral frontal lobes with widening of interhemispheric fissure and the frontal lobes acquiring a peak like configuration - causing tension pneumocephalus-"Mount Fuji sign." Tension pneumocephalus occurs when air enters the extradural or intradural spaces in sufficient volume to exert a mass or pressure effect on the brain, leading to brain herniation. Tension pneumocephalus is a surgical emergency, which needs immediate intervention in the form of decompression of the cranial cavity by a burr hole or needle aspiration. The Mount Fuji sign differentiates tension pneumocephalus from pneumocephalus. Keywords: Mount Fuji, neurosurgical emergency, tension pneumocephalus
How to cite this article:
Sanyal P, Bele K, Vishwanath Rai SP. Tension pneumocephalus: Mount Fuji sign. Arch Med Health Sci 2015;3:352-3 |
A 13-year-old male was operated by craniotomy for a tumor in right periventricular caudo thalamic groove involving right lateral ventricle and third ventricle. The histopathology of the tumor suggested an Astrocytoma. The postoperative computed tomography (CT) showed thin collection of air in the frontal subdural regions [Figure 1]a-c]. During the late postoperative period, he had generalized weakness and drowsiness and vomiting. A noncontrast CT scan was done [Figure 1]d and e], which showed massive subdural air collection [Figure 1]e white arrow] causing compression of bilateral frontal lobes with widening of interhemispheric fissure and the frontal lobes acquiring a peak like configuration [Figure 1]e and f black arrow]-"Mount Fuji sign." [1],[2]  | Figure 1: Postoperative computed tomography (CT) shows thin collection of air in the frontal subdural regions. (a-c) CT done in the late postoperative period. (d and e). Massive subdural air (e white arrow) compressing frontal lobes; widening interhemispheric fi ssure acquiring a peak like configuration (e black arrow). (f). Mount Fuji peak – downloaded free from http://en.wikipedia.org/wiki/Mount_Fuji
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Pneumocephalus denotes the presence of air within the cranial cavity. It occurs most commonly as a result of trauma. Other causes include tumor, infection and fistulas between intracranial cavity and external air spaces. Iatrogenic pneumocephalus may be a result of intracranial or sinus surgery, ventriculopleural and ventriculo-peritoneal shunting, and lumbar puncture. [2],[3]
Tension pneumocephalus occurs when air enters the extradural or intradural spaces in sufficient volume to exert a mass or pressure effect on the brain, leading to brain herniation.
Tension pneumocephalus can be a neurosurgical emergency when associated with neurological deterioration. [4] The Mount Fuji sign differentiates tension pneumocephalus from nontension pneumocephalus. Extension of air in between the tips of the frontal lobes suggests that the pressure of the subdural air exceeds the surface tension of cerebrospinal fluid between the frontal lobes. [5] In the presence of relevant clinical findings, this sign is an indicator of a neurosurgical emergency.
Mount Fuji is the highest mountain in Japan [Figure 1]f]. It's an active stratovolcano that last erupted in 1707-08. Mount Fuji's exceptionally symmetrical cone, which is snow-capped several months a year, is a well-known symbol of Japan and it is frequently depicted in art and photographs, as well as visited by sightseers and climbers. [6] When there is compression of the frontal lobes by subdural air collections without the characteristic separation of the frontal lobes, it has been described as a "peaking sign," analogous to the Mount Fuji sign.
| References | |  |
| 1. | Michel SJ. The Mount Fuji sign. Radiology 2004;232:449-50.  |
| 2. | Vanhoenacker FM, Herz R, Vandervliet EJ, Parizel PM. The Mount Fuji sign in tension pneumocephalus. JBR-BTR 2008;91:175. |
| 3. | Campanelli J, Odland R. Management of tension pneumocephalus caused by endoscopic sinus surgery. Otolaryngol Head Neck Surg 1997;116:247-50. |
| 4. | Por YC, Barcelo CR, Salyer KE. Extradural tension pneumocephalus after posterior cranial vault remodeling for ventriculoperitoneal shunt-induced craniosynostosis. J Craniofac Surg 2005;16:504-8. |
| 5. | Ishiwata Y, Fujitsu K, Sekino T, Fujino H, Kubokura T, Tsubone K, et al. Subdural tension pneumocephalus following surgery for chronic subdural hematoma. J Neurosurg 1988;68:58-61. |
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