Pulmonary embolism (PE) is a severe complication in neurosurgery. The best treatment of PE is thrombolytic therapy, but the presence of either intracranial neoplasm or recent neurosurgical procedures is considered a major contraindication to this therapy. We have used urokinase thrombolytic therapy in nine of our patients with severe PE that occurred from 7 to 34 days after a neurosurgical operation. All patients survived. No intracranial hemorrhage occurred. We also advocate thrombolytic therapy for severe PE in patients who were recently operated on by neurosurgical procedure.