Tension Pneumocephalus After Frontal Sinus Balloon Dilation due to Inadvertent Skull Base Entry: A Cautionary Case Emphasizing Preoperative Anatomic Assessment

Balloon sinus dilation is widely utilized for the management of chronic rhinosinusitis and is generally considered safe when employed in appropriately selected patients. However, successful frontal sinus balloon dilation may be technically challenging due to the complexity of the frontal recess anatomy and is associated with potentially serious complications including skull base injury. We report a case of a 78-year-old man who developed acute tension pneumocephalus following office-based frontal balloon sinuplasty due to inadvertent skull base entry in the setting of complex frontal recess anatomy. The patient required emergent open craniotomy followed by definitive endoscopic skull base repair at a tertiary care center. This case highlights the importance of careful review of preprocedural computed tomography scans of the sinuses and appropriate patient selection when considering frontal sinus balloon dilation.