Introduction: Air within cranium may be classied according to the site of occurrence. The pathophysiology of the same is varied and the effects are manifold. Methods: Patients with tension pneumocephalus are taken up for surgery.Results: In controlled decompression group, the pain requirement and duration of hospital stay was more. The air replacement procedure group had more recollection and one patient required a second procedure.Conclusion: Most of the cases subside with normobaric 100% oxygen therapy. In patients with persistent pneumocephalus for more than two weeks, more denitive procedures for sealing of the dural rent may be required.