The authors report two cases of destructive cranial lesions associated with Mycobacterium tuberculosis–HIV coinfection in a male and female cadaver. Both cadavers were of African origin, from the Western Cape, South Africa. The authors present grossly abnormal tuberculosis–associated lesions of the anterior and middle cranial fossae, involving the ethmoid and sphenoid bones. Both individuals presented with tubercular intrasellar masses and obliteration of the paranasal sinuses. Current literature on cases such as these are extremely rare and others typically focus on lesions of the calvarium. Here we report on the gross anatomical findings as well as the relevant anatomical aspects of the probable aetiology. Both cases presented here hold interest for medical professionals in Africa and other geographic regions. It further illustrates the importance of understanding the venous drainage of the paranasal sinuses when considering the manifestation and treatment of extrapulmonary TB.