Incidence and Management of Venous Air Embolisms during Awake Deep Brain Stimulation Surgery in a Large Clinical Series

Abstract

Background/Aims: Venous air embolism (VAE) is a potential complication during neurosurgical procedures, particularly in the sitting position. The diagnosis and management of VAE in patients undergoing awake deep brain stimulation (DBS) lead implantation in the sitting position are underreported. Methods: We performed a retrospective chart review of 467 consecutive DBS surgeries at the University of California, San Francisco. Data was collected for patient demographics, diagnosis, intraoperative events, and postoperative course. Results: Six cases of clinically diagnosed VAE were found, amounting to a total incidence of 1.3% per procedure. We did not observe a statistical association with patient age, diagnosis, or DBS target. The most common symptoms of intraoperative VAE were coughing, oxygen desaturation, and hypotension. In all cases, VAE was treated by copious irrigation of the surgical field and lowering the patient’s head. In 4 cases, DBS implantation was abandoned because of ongoing symptoms of VAE. The respiratory outcome in all patients was good after several days of close observation. Conclusion: The incidence of VAE during DBS procedures is small, but prompt recognition and management of VAE are critical to avoid further associated complications.

An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery

“…Low-probability VAE was defined as an isolated coughing episode without other signs and symptoms. 10 Our patient presented low probabilities during the first burr hole and high probabilities during the second burr hole. The differential diagnoses that can be considered for our patient were bronchospasm, aspiration pneumonia, acute myocardial infarction, opioid overdose, and venous thrombo-embolism.…”

“…10 In our case, the presentation of intermittent and mild cough during the first burr hole might be controlled with continuous saline irrigation and bone wax by the surgeon during the procedure. However, because of acute explosive cough associated with hypoxia and apnoea during the second burr hole, we had to back mask ventilation, followed by repositioning of the head and insertion of PLMA for assisted ventilation.…”

“…9 Chang et al reviewed a larger number of patients, 467 from consecutive DBS surgeries, and the results showed the incidence of clinically diagnosed VAE was only 1.3% based on the presentation of the most common symptoms such as coughing, oxygen desaturation and hypotension. 10 However, the pathophysiology of cough and tachypnoea during VAE is still not well understood. It has been suggested that the coughing encountered during VAE could be due to the cytokines and complement released during the lung's immune response to transient ischaemia.…”

Embolismo aéreo venoso en neurocirugía

“…Chang et al, encontraron una incidencia de 1,3% de EAV en una serie retrospectiva de 467 pacientes sometidos a estimulación cerebral profunda 5 . Otros estudios recientemente publicados han reportado una incidencia de 3,2% de EAV en la cirugía de estimulación profunda en una serie retrospectiva de 287 casos y una incidencia de 4,5% en una serie prospectiva de 22 casos 24 .…”

“…El riesgo de EAV está presente en todo tipo de procedimientos neuroquirúrgicos, sin embargo, su incidencia es mayor en procedimientos donde es necesaria la posición sentada 4 o semisentada 5,6 . La incidencia de embolismo aéreo en posición sentada es variable pero se ha descrito hasta en un 45% de los casos 7 .…”