Background: Craniotomy and tumor resection are critical neurosurgical procedures often performed to manage life-threatening intracranial conditions, such as tumors and hemorrhages. Despite their therapeutic benefits, these interventions carry a high risk of postoperative complications that can significantly affect patient outcomes. Early detection of such complications is essential for timely intervention and improved prognosis. Computed Tomography (CT) plays a crucial role in the early postoperative setting by enabling rapid identification of hemorrhage, pneumocephalus or midline shift, making it an indispensable tool in acute neurosurgical care. This study aims to retrospectively analyze the prevalence and characteristics of the most common postoperative findings following craniotomy and evaluate the effectiveness of CT imaging in their detection. Methods: A retrospective analysis was guided on 70 patients (40 males, 30 females; mean age 45.0 years , range 20–86 years ) who underwent craniotomy at King Abdulaziz University Hospital between 2015 and 2024. Postoperative CT imaging was performed using standardized protocols, and findings were reviewed by board-certified radiologists. Results: The three most common indications for surgery were Hemorrhage (27.1%), malignant neoplasms (24.3%), meningioma (15.7%). Pneumocephalus was the most frequent complication (70.0%), followed by hemorrhagic changes (61.4%), cerebral edema (45.7%), midline shift (22.9%), and brain herniation (14.3%). The majority of complications were identified within the first postoperative week (88.6%). Conclusion: Postoperative CT imaging plays a vital role in the early identification of complications following craniotomy, with pneumocephalus being the most commonly observed. The findings emphasize the importance of routine CT scans within the first postoperative week for timely clinical intervention. CT has proven to be a practical and accessible tool that significantly improves patient outcomes in the postoperative neurosurgical setting.