A patient aged 48-year-old, presented to the outpatient department with neck pain and weakness of all the limbs for three months. On examination, he had power 3/5 in all the limbs with bilateral hand grip weakness of 50%. Neuroimaging study showed a dumbell shaped lesion with compression of the spinal cord in the cervical region that was identified as a C4/C5 neurofibroma. Cervical laminectomy and excision of the tumour and unilateral lateral mass screw and rod fixation was done. Post operatively patient was discharged with improved motor power. One month after surgery, he presented with bulging at the operative site, which was diagnosed as a pseudo meningocele that did not respond to conservative therapy. As swelling was increasing size and becoming tense and also complaining of severe neck pain and postural hypotension, it was managed surgically, three months after first surgery, by excision of pseudo meningocele with primary repair of dural defect with muscle graft and lumbar drain inserted intraoperatively which was removed after five days. Patient’s neck pain and hypotensive episode were improved after repair. Possible causes for the development of post-operative pseudo meningocele can be soft tissue and paravertebral muscle damage or high intradural pressures that causes leakage of cerebrospinal fluid from a very small dural defect. Shunt insertion should be reserved for patients with impaired cerebrospinal fluid absorption or those with a refractory fistula, despite medical therapies and direct surgical repairs
