The rhinosinusitis diseases are common and that complications are rare intracranial extension consisting of the infectious process into adjacent structures. The extra-dural empyema is an even rarer complication can lead to devastating neurological sequellae. Early diagnosis using clinical criteria with the aid of radiological examinations such as computed tomography and / or nuclear magnetic resonance are essential for the institution of appropriate therapy. OBJECTIVE: We report a case of extra-dural empyema as a complication of isolated sphenoidalis describing signs, symptoms, radiological findings and treatment by endoscopic sinus surgery. Methods: Male patient, 14 years old, complaining of severe frontal headache and left peri-orbital associated with nausea and vomiting. She sought medical emergency several times receiving medical treatment at home. After a significant worsening of neurological symptoms and was hospitalized and asked where it was found radiological sphenoidalis isolated with extra-dural empyema on the left. It was then started treatment with Ceftriaxone, vancomycin and Metronidazol with Otolaryngological assessment. The patient then underwent left sinusotomy sphenoid endoscopic treatment. RESULTS: Despite the delay in diagnosis, there was drainage of the sphenoid sinus and empyema without complications. The patient had an uneventful recovery and / or postoperative sequellae. CONCLUSION: Endoscopic surgery is a safe and comfortable for the treatment of complicated sphenoidalis isolated or not. It should be stressed however the importance of imaging in suspected cases and early diagnosis.