Background: Pneumocephalus is the presence of air within the skull. Tension pneumocephalus develops whenever air inside the skull accumulates or is under pressure. Endoscopy is frequently used in the management of cerebrospinal fluid leak however rarely used for the treatment of tension pneumocephalus.

Case Description: We present a case of a 64-year-old man diagnosed with a right frontal depressed skull fracture. He underwent a craniotomy, however a second Computerized Tomography revealed the emergence of a tension pneumocephalus. After 3 successive endoscopic surgeries, the patient showed complete recovery.

Discussion: The present case proved once again the efficiency of endoscopy in treating pneumocephalus. The presenting causes, symptoms and treatment options for pneumocephalus are reviewed.           

Keywords: Tension pneumocephalus, endoscopic repair, CSF leak, head trauma.