The existence of air within the skull has been called pneumocephalus. Treatment of pneumocephalus is mostly managed surgically, especially in a tension pneumocaephalus when the pressure has to be alleviated. Dural defect can be treated with the suture technique and tissue adhesives such as butyl 2-cyanoacrylate (B 2-CA). Otogenic pneumocephalus due to dural defect can be managed with B 2-CA tissue adhesive cheap, safely, and effectively without complication. We thought it would be of interest to present a case of pneumocephalus due to traffic accident 12 years ago and managed with B 2-CA. It is concluded that B 2-CA fixation can be alternative for dural defect closure with suturing or other tissue adhesives. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.