Pneumocephalus is defined as the air seen in epidural, subdural, or intraventricular distance under bones forming calvarium. Although it is commonly reported after skull base fractures depending on head trauma or after cranial surgery, rarely it has also been reported to be seen spinal surgery. Many theories have been suggested to explain symptomatic pneumocephalus occuring after spinal surgery. Placing vacuum drainage to the operation area, repairing dural injury for a long time, extensive tissue dissection and long-term retraction which have been suggested to help in the formation of pneumocephalus secondary to dural injury during spinal surgery. In addition to these, previous performed cranioplasty can be a factor to developing the tension pneumocephalus secondery to dural injury during lumbar spine surgery. When the dural tear occurring during surgery in cases with craniectomy and these patients should be monitored carefully for increased intracranial pressure in the postoperative period. (C) 2016 The Authors. Published by Elsevier B.V.