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Tension pneumocephalus can be a life-threatening complication following cranial surgery. We report a 14-year-old female who developed tension pneumocephalus following her most recent external approach to a recurrent pilocytic astrocytoma of the skull base and clivus. Because the risk of devascularization of the recently placed bone grafts was a concern, an endoscopic approach was chosen instead of a cramotomy. Endoseopic decompression was accomplished by opening the anterior ethmoid and frontal recess air cells after performing an uncinectomy. The nasofrontal recess areas were then packed from below with grafts of muscle and fascia lata. Follow-up magnetic resonance imaging (MRI) at three and eight months showed complete resolution of the intracranial air. At two-year follow-up, the patient is still asymptomatic. This case report presents treatment of tension pneumocephalus through endoscopic decompression and closure of the nasofrontal recess as a viable option if significant risks are associated with craniotomy and the status of the mucosa of the nasal frontal recess is known.