Frontal Sinus Osteoma Causing Tension Pneumocephalus and Acute Hemiparesis: A Rare Neurological Complication

Frontal sinus osteomas are typically benign and asymptomatic lesions. However, in rare instances, they can erode the posterior sinus wall, leading to tension pneumocephalus, a neurosurgical emergency. We report the case of a 33-year-old female presenting with progressive headache and right-sided hemiparesis. MRI and CT imaging revealed a large frontal sinus osteoma eroding the posterior table and resulting in tension pneumocephalus. The patient underwent frontal craniotomy, osteoma excision, dural repair, and sinus exteriorization. Postoperatively, her symptoms resolved completely, and follow-up imaging showed no recurrence. Tension pneumocephalus is a rare but serious complication of frontal sinus osteomas. Early diagnosis, combined with neuroimaging and surgical management, is essential for achieving favorable outcomes.