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Acute mental status changes following craniotomy for acoustic tumors demand prompt evaluation and treatment to avoid serious morbidity and mortality. Two cases of acute obstructive hydrocephalus complicating the postoperative period following translabyrinthine craniotomy are presented. Diagnosis is made with noncontrast computed tomography scanning. Treatment is rendered at the bedside with placement of a ventriculostomy. Diagnosis and management implications for acoustic tumor patients are discussed.