Introduction: Manypatients withemphysemawill develop cystic air spaces in the lung parenchymaknownas bullae. Positive pressureventilation increases the pressure in a bulla and increases the risk of rupture and tension pneumothorax. Therefore, anesthesiamanagement, for surgeries other than lung volume reduction surgery (LVRS), is challenging in these patients.Case Presentation: A 62-year-old male patient was brought to the emergency department due to a fall resulting in head trauma anda leak of CSF from a previous surgical site of a CP (cerebellopontine) angle tumor. The chest CT scan depicted bilateral bullae in thelungs. Anesthesia was induced and maintained with an inhalational method using Sevoflurane and spontaneous mask ventilation.Conclusions: Patients with bilateral bullae could be managed with spontaneous ventilation; one of the safe choices is inhalationalinduction and maintenance with Sevoflurane