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Background: Tension pneumocephalus, the accumulation of intracranial gas under pressure, is a rare but potentially life-threatening condition which can complicate craniofacial surgery, trauma, or cranial tumor. It presents as an acute or subacute expanding mass lesion. Case Report: We present a case of a 40-year-old male who developed tension pneumocephalus as a consequence of a previously detected but untreated frontal sinus osteoma. Despite prompt decompression and repair of the fistulous connection between the sinus and the intracranial compartment, the patient suffered permanent frontal lobe damage with significant neurocognitive sequelae and seizures. Conclusions: This case illustrates that tension pneumocephalus can be a dangerous entity with potential for early mortality and long-term morbidity. We recommend, therefore, early treatment and close follow up of destructive lesions involving the posterior frontal sinus wall. RESUME: Pneumo-encephale severe compliquant un osteome du sinus frontal: a propos d'un cas. Introduction: Le pneumo-encephale sous tension, une accumulation de gazes sous pression, est une palhologie rare mais potentiellement mortelle qui peut compliquer une chirurgie craniofaciale, un traumatisme ou une tumeur cranienne. II se pr&ente comme une ldsion expansive aigue ou subaigue. Histoire de cas: Nous presentons le cas d'un homme de 40 ans qui a developpe un pneumo-encephale sous tension a la suite d'un ostdome du sinus frontal deja connu mais non traite\ Malgre une decompression rapide et une reparation de la fistule entre le sinus et le compartiment intracranien, le patient a subi un dommage permanent au lobe frontal avec des sequelles neurocognitives importantes et des crises d'epilepsie. Conclusion: Ce cas illustre que le pneumo-encfiphale sous tension puet etre une condition dangereuse avec un potentiel de mortalite precoce et de morbidity a long terme. Nous recommandons done un traitement prficoce et un suivi serre des lesions destructrices impliquant la paroi postfirieure du sinus frontal.Can. J. Neurol. Sci. 1998; 25: 79-81 Pneumocephalus is defined as an intracranial collection of gas in subdural, subarachnoid, intraventricular, extradural or intracerebral compartments. Tension pneumocephalus, or the accumulation of intracranial gas under pressure, has numerous etiologies, and can present with neurologic symptoms that mimic other more common space-occupying lesions. We describe a patient who presented with symptoms related to tension pneumocephalus secondary to an osteoma of the frontalethmoid sinus. We discuss the implications for sinus osteoma management and emphasize the potential for long-term morbidity from this life-threatening complication. CASE PRESENTATIONA 40-year-old male was incidentally found to have a right ethmoid sinus tumor, felt to most likely represent an osteoma. He refused surgical intervention. Approximately ten years later, he presented to the Emergency Department with a four day history of bifrontal headache, confusion and behaviour changes. ...