Objectives We herewith report the case of a 43-year-old patient who experienced a skull base fracture associated with minimal trauma. The computed tomography scan examination showed unusual extensive pneumatization of the skull base. This patient used to perform repeated Valsalva maneuvers on a daily basis since childhood. Methods A literature search and analysis of pneumatization mechanisms was performed. Results Extensive skull base pneumatization has already been reported in patients performing daily Valsalva maneuver. Two pathogenic hypotheses are discussed: the bone cavity expansion through communicating spaces and cavitation secondary to increased intra-osseous pressure transmitted via the venous network with subsequent bone marrow ischemia. Conclusion Valsalva maneuver may be the cause of an extensive skull base pneumatization. We hypothesize that the Valsalva maneuver may induce bone marrow ischemia that may, if repeated and prolonged, lead to pneumatization.