Die intraoperative venöse Luftembolie bei funktionellen neurochirurgischen Eingriffen in halbsitzender Position

Precise electrode placement is crucial in deep brain stimulation (DBS). This may be compromised by brain shift caused by cerebrospinal fluid leaking or pneumocephalus. Therefore, it is an option to elevate the head. This, however, carries an increased risk of venous air embolism. Here we analyze the occurrence and management of this complication in a large consecutive series of patients.

We performed a retrospective analysis in a series of 634 functional stereotactic operations head elevated. Surgery was performed while the patients were awake in 567 instances. Any clinical signs for air embolism such as increased throat clearing, coughing and circulatory problems were scrutinized.

A total of 263 women and 371 men with a median age of 55 years were operated. The majority of patients underwent DBS (614), while a subset had radiofrequency lesioning procedures (20). Increased throat clearing and slight coughing occurred in about 5 % of procedures, which stopped after sealing the burrhole with wax. Three patients (0.47%) had clinically relevant intraoperative venous air embolism: a 76-year-old man with PD, a 54-year-old man with tremor, and a 50-year-old woman with cervical dystonia. All three patients were cardiovascular stable and the surgery could be finished without further complications after sealing the burrhole, flushing the site with fluid, and tilting the upper part of the operation table backwards.

Stereotactic functional surgery with elevation of the head is a generally safe procedure with a low risk for intraoperative venous air embolism. Immediate reaction to the signs of venous air embolism allows the procedure to be completed.