Tension pneumocephalus is a rare and potentially fatal neurological disease. To avoid deadly consequences, it demands urgent and rapid intervention. The most prevalent cause of tension pneumocephalus is a head injury. Air can enter the cranium by a fracture affecting the paranasal sinus or the middle ear cavity, or even more rarely, through a complex depressed fracture of the skull vault. Its treatment consists of a simple twist drill and aspiration of intracranial air with or without the insertion of an underwater seal. 100% oxygen should be delivered using a non-breathable mask that hastens air resorption. The authors provide a series of five examples with post-traumatic tension pneumocephalus, focusing on its treatment and review of literature
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