We report a case of a 22-year-old man presenting with a fourth ventricular tumour and associated chronic obstructive hydrocephalus likely leading to thinning of the cranium. Intraoperatively, he developed an epidural hematoma secondary to a fracture of the temporal bone by application of the three-point skull fixator. This is the second reported adult case of an iatrogenic epidural hematoma secondary to pin-site complications. We advocate the careful placement of the pins and suggest the tightening force be catered individually especially in pediatric patients or patients with chronic hydrocephalus.