Background: Intracranial involvement in complicated sinusitis is a rare but potentially fatal process. This study aimed to assess the role of radiological diagnosis in assessment and timing of surgical intervention in sinusitis patients complicated with intracranial complications. Patients and Methods: This retrospective cross sectional study was conducted in ENT and Radiology Departments, Faculty of Medicine, Zagazig University on 24 cases with sinusitis complicated with intracranial complications. Results: Included 12 patients had cavernous sinus thrombosis 50% of them were males with mean age of 65.4 years. They were presented with facial pain, facial edema, fever, proptosis, nasal obstruction and headache. 2 male patients had lateral sinus thrombosis with mean age of 61.4 years, they were presented with headache. 2 patients had meningitis, one male and other female with mean age of 41 years. They were presented with convulsion, fever and headache. CT of paranasal sinuses (PNS) showed sphenoidal sinusitis with mucosal thickening. CT Brain was irrelevant. MRI brain showed leptomeningeal enhancement, distention of subarachnoid space and widening of interhemispheric fissure. All patients underwent surgical debridement of diseased tissues with anticoagulant therapy. One patient died (50%). Conclusions: Both CT scan and MRI of the sinuses are mandatory in any patient presenting with features suggestive of intracranial complicated sinusitis.