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Inverting papilloma is a locally aggressive neoplasm; however, intracranial extension is very rare. The authors herein report a case of massive inverting papilloma with intracranial extension and an associated frontal sinus mucocele, causing marked frontal lobe compression. Treatment consisted of combined anterior craniofacial resection. Magnetic resonance imaging provided accurate preoperative differentiation between neoplasm and inflammation. Skull base reconstruction may prove more difficult when there is significant frontal dead space resulting from chronic brain displacement by an associated mucocele. The management of this unusual neoplasm and a review of the literature is presented.