Iatrogenic dural tears during lumbar spine surgery are not uncommon and may have multiple long-term sequelae if not managed promptly and definitively. Sequelae include pseudomeningocoeles due to a persistent cerebrospinal fluid leak, which may result in a subarachnoid hemorrhage or subdural hematoma. These, in turn, can lead to adult communicating hydrocephalus. The purpose of this study is to describe a case of an intraoperative iatrogenic dural tear leading to the formation of a pseudomeningocoele and progressing to hydrocephalus.