A report was performed for the clinical data of one patient with massive brain swelling after cranioplasty （MBSC）. This male patient， aged 38 years， showed seizures and pupillary changes within a short period of time after cranioplasty， and cranial CT revealed significant swelling of the left cerebral hemisphere. The patient died within 72 hours after surgery even after dehydration and antiepileptic treatment. And after the report a literature review was conducted， to investigate the clinical features， pathogenesis， and preventive measures of MBSC.