A 57-year-old man presented to the A&E with loss of consciousness due to a motorcycle collision 9 h prior. Upon initial examination, the patient had a GCS of E4M6V5. The patient had no other symptoms that required inpatient care. The patient also had no history of bloody discharge from the external auditory meatus. The patient's past medical examination shows no other history of past illness and surgery. He reported family history shows the patient's parents died due to heart attacks. Further examination with a head CT scan revealed minimal PNC forming in the right frontal region (, ). The patient was first admitted to the A&E then requested for discharge against medical advice after 5 days of inpatient care. Ten days later, the patient then came to the outpatient clinic, complaining of severe headache and rhinorrhea developed, prompting the patient to return for re-examination. The patient exhibited right-sided hemipharesa with a GCS of E2V2M4 on the second visit. A second CT scan revealed massive PNC far more severe than evident in the previous CT scan (). Bone reconstruction showed a right frontal linear fracture (). The final assessment concluded that the patient suffered from a tension PNC. An operation was then performed to drain the PNC and seal the cranial defect. The operation was performed via a bicoronal incision. A burr hole in the calvarium was created at the highest convexity to release the PNC, and the cranial defect was closed using a pericranial rotational flap (). The diameter of the defect was measured, and a flap with the same diameter was drawn adjacent to the defect. The pericranium was sacrificed to obtain clear margins, and the underlying bone was drilled. He was given an intravenous broad-spectrum antibiotic ceftriaxone (1 g, administered for 5 days) and analgesics drugs (ketorolac, 30 mg intravenous if necessary, not exceeding 5 days). Post-operative was unremarkable, with discharge and rehabilitation taking 6 days for a total of 7 days of inpatient care. Post-operation, the patient's headache and rhinorrhea decreased. The patient was followed up every 3 days for the first week. Sutures were removed 2 weeks post-operative. The patient was then observed every 2 weeks for 3 months. Complaints were minor, consisting of mild headaches. The wounds healed with minimal scarring, and the cosmetic outcome for the craniofacial fracture was acceptable to the patient.