Abstract The presentation and management of 33 patients with traumatic pneumocephalus have been analysed and two main groups recognized. The first consisted of 12 patients who developed an intracerebral aerocele, the onset of which was delayed for up to 52 days from the time of injury. These patients presented with signs of raised intracranial pressure which required urgent surgical treatment. The intracranial air in the second group was situated in the subdural or subarachnoid spaces and was usually visible on the first X-ray taken after injury. Adequate early prophylactic antibiotic treatment against meningitis was of great importance to these patients, who did not all require surgical intervention.