Postoperative tension pneumocephalus following cerebral aneurysm surgery in supine position without prior lumbar drainage

The occurrence of tension pneumocephalus in neurosurgeries done in the supine position is scarcely reported. We present a case of 57-year-old man who developed tension pneumocephalus postoperatively, following cerebral aneurysm surgery, in supine position, where lumbar drainage before clipping surgery was not done. The patient's neurological status deteriorated rapidly, characterized by convulsion and unresponsiveness to external stimuli, 1 h following the uneventful surgery. Immediate computed tomography scan revealed bi-frontal tension pneumocephalus. Long duration of surgery and cerebrospinal fluid loss were assumed to be the causative factors. The patient was treated immediately with frontal drill hole evacuation for intracranial air, which saved the patient from a life threatening complication.