A sphenoidal resection of a 34-mm nonfunctioning pituitary macroadenoma with optic chiasmal compres- sion. Cerebrospinal fluid (CSF) leak was noted and re- paired with gelfoam and a duraseal (hydrogel sealant) buttressed with Nasopore. Day 4 postsurgery, she had ongoing postnasal drip, and she rapidly deteriorated with headaches, drowsiness, vomiting, and urinary inconti- nence. She was receiving adequate hydrocortisone re- placement, serum sodium levels were normal, and CSF cultures excluded infection. Brain computed tomography (CT) showed significant pneumocephalus with mass effect (Figure 1). Figure 2 shows air in the prefrontal region (Mount Fuji sign) and cisterns (air bubble sign) on coronal sections.
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