DISCUSSION: The neuroendocrine tumors of head neck region are divided in 3 categories based on histology and IHC. 1) Well differentiated CT, <2 mitotic count/10HPFs, Ki-67<2% 2) Atypical carcinoid with 2-10mitotic count/10HPFs, Ki-67 between 3-20% and 3) Small cell cancer, mitotic count of >10/10 HPFs and Ki-67>20%. Although regional metastasis is not uncommon, only 2 cases of distant metastasis have been reported in the past. Our patient was diagnosed to have atypical carcinoid but the Ki-67 was >70% which is consistent with small cell cancer. Carcinoids are a known cause of hypercoagulable state and rarely cause dural sinus thrombosis. However, this is the first case of dural sinus thrombosis with CTME. Whether local invasion or metastatic disease or hypercoagulable state or all of them are responsible, is unknown.