Background: Giant acute extradural hematoma following titanium mesh cranioplasty is very rare. Case Report: We report a giant post-cranioplasty extradural hematoma which required surgical evacuation and removal of titanium implant. The titanium mesh cranioplasty was done for a post-craniectomy defect from right sided decompressive craniectomy for right fronto-temporo-parietal acute subdural hematoma (aSDH) and contusion. On surgical evacuation, patient recovered. Later on repeat titanium mesh cranioplasty was done with no complications. Conclusion: This case report intends to warn against a potential dangerous complication following cranioplasty in the post-operative period that must be kept in mind while doing post-operative care.