title: Stereotactic biopsy complicated by pneumocephalus and acute pulmonary edema.
abstract: BACKGROUND
  The aim of this study was to describe pneumocephalus as a rare complication of stereotactic biopsy and as a possible cause of acute neurogenic pulmonary edema.
  
  
  METHODS
  A case of frameless stereotactic biopsy complicated by pneumocephalus presenting with acute lung injury 48 hours after the procedure. A frameless stereotactic procedure was performed in the standard fashion. Immediate postoperative CT showed no intracranial air except for a gas inclusion at the biopsy site within the lesion. The skin staple placed at the end of surgery on the skin incision was removed 36 hours later. A CT scan performed 48 hours postoperatively showed new pneumocephalus. The patient exhibited acute respiratory distress but no new neurologic symptoms. There was no detectable systemic cause for the pulmonary edema. The patient received supportive respiratory treatment and fully recovered.
  
  
  CONCLUSIONS
  Pneumocephalus is apparently a rare complication of stereotactic brain biopsy and one that may result from early removal of the skin staple or suture. The occurrence of acute neurogenic pulmonary edema may be attributed to the pneumocephalus.
authors.affiliation: Department of Neurosurgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv 64239, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roth
authors.forename: Itzik
authors.initials: I
authors.lastname: Avneri
authors.forename: Adi
authors.initials: A
authors.lastname: Nimrod
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Kanner
mesh_terms: D000368:Aged; D001254:Astrocytoma / Q000473:pathology*; D001707:Biopsy, Needle / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D038361:Neuronavigation / Q000009:adverse effects*; D011007:Pneumocephalus / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy