Fiberoptic Bronchoscopy in the Presence of Space-occupying Intracranial Lesions

The performance of flexible fiberoptic bronchoscopy (FFB) has anecdotally been considered to carry a high risk of neurologic complications in patients with raised intracranial pressure (ICP). There is no evidence in the literature to support this concern. We evaluated this risk by reviewing hospital records of 132 patients who underwent FFB and computer tomography of the central nervous system (CNS-CT) during the same hospitalization. Twenty-nine patients had CT evidence of increased ICP. For the purpose of analysis, patients were divided into two groups: 17 patients had evidence of raised ICP prior to the performance of FFB and had received treatment with an intent to lower the ICP, and 12 patients in whom increased ICP was not suspected at the time of FFB and therefore did not receive any form of pretreatment. There was no evidence of neurologic complications in either group during the first postbronchoscopy week. We conclude that FFB carries a low risk in patients with elevated ICP.