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Tension pneumocephalus is a rare complication of craniotomy, however, it should be managed promptly due to rapid neurological deterioration. We report a case of tension pneumocephalus after transsphenoidal surgery for a giant pituitary tumor. It may have developed because of the cerebrospinal fluid rhinorrhea and presence of an external lumbar drain. Key words:Tension pneumocephalus;Transsphenoidal surgery;CSF Rhinorrhea;External lumbar drain;Giant pituitary tumor.