Extreme calvarial and upper cervical hyperpneumatization: a case report

Pneumatization of bones of cranial base other than mastoid process and temporal bone is a pathologic and rare condition, and it may cause some serious complications. Its extension to the cranial vault and upper cervical bones is extremely rare. A 67 year-old man was admitted with complaint of chronic nonspecific headache for a long time. He had no history of head trauma, or otologic infection. Physical examination revealed no evidence of fever, a palpable swelling, rhinorrhea, or otorrhea. There was only a slight right sensorineural hearing loss. On brain computerized tomography (CT) revealed hyperpneumatization of the right mastoid process and right temporal bone, bilateral occipital, parietal and frontal bones, and right side of the atlas. There was not pneumocephalus, but there was free air under the scalp of the right suboccipital region and around the right condyle, right transverse process of the atlas and right paravertebral region of the upper cervical spine. Extrathecal cerebrospinal fluid (CSF) leakage was not determined by CT cysternography with intrathecal contrast administration and by the radionuclide cysternogram imaging.