Pneumocephalus following transphenoidal surgery is a rare event normally presenting immediately.1 We present a case of pneumocephalus combined with cerebrospinal fluid (CSF) rhinorrhea in a patient whose transphenoidal pituitary surgery took place 24 years previously. Her interim history is further complicated by years of intranasal cocaine abuse. To our knowledge, pneumocephalus occurring at such an interval following transphenoidal surgery has not been previously reported. This case report was deemed exempt from review by the institutional review board at our institution.
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