Idiopathic Craniocervical Hyperpneumatization with Pneumorrhachis

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A 57-year-old male patient presented with atraumatic pain in the region of the upper cervical spine radiating into both arms without sensorimotor deficits. Computed tomography demonstrated multiple intraosseous air pockets in the region of the skull base and the upper cervical spine as well as in the spinal canal (pneumorrhachis). Since an interdisciplinary ENT consultation was unable to identify a causative pathology, idiopathic craniocervical hyperpneumatization with pneumorrhachis was diagnosed. This is a rare anomaly on which there is only a handful of case reports. It is postulated that increased middle ear pressure causes air to escape via the mastoid sinus. The air diffuses into the surrounding structures, thereby not remaining restricted to one structure. Due to the fact that various cavities are anatomically connected, numerous structures can be involved. The precise pathophysiological mechanisms have not been elucidated as yet. The increase in pressure is believed to be caused by frequent Valsalva maneuvers (for example, in divers, parachutists). In the majority of cases of hyperpneumatization, no cause can be determined. Under the prescribed analgesia, the patient was symptom-free in the clinical follow-up at 1 week and 3 months.

Dr. med. Yama Afghanyar, Prof. Dr. med. Frank Traub, PhD, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Zentrum für Orthopädie und Unfallchirurgie, Mainz, [e-mail]

Dr. med. Tobias Jorg, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Mainz

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Afghanyar Y, Jorg T, Traub F: Idiopathic craniocervical hyperpneumatization with pneumorrhachis. Dtsch Arztebl Int 2024; 121: 688b.
DOI: 10.3238/arztebl.m2024.0100