Acta Neurochirurgica

, Volume 152, Issue 12, pp 2047–2052 | Cite as

Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery

  • Jules M. NazzaroEmail author
  • Kelly E. Lyons
  • Robyn A. Honea
  • Matthew S. Mayo
  • Galen Cook-Wiens
  • Amith Harsha
  • Jeffrey M. Burns
  • Rajesh Pahwa
Clinical Article



The objective of the present study was to evaluate the risk of pneumocephalus, venous air embolism (VAE), and intracranial hemorrhage in subthalamic nucleus (STN) deep brain stimulation (DBS) patients operated in the strict supine (head and body flat) position.


This was a retrospective review of clinical records and brain imaging of patients who underwent STN DBS between January 2007 and June 2009 at the University of Kansas Medical Center.


A total of 61 patients underwent 114 lead implantations (53 staged bilateral and 8 unilateral). No case involved a transventricular route. Intracranial air volumes ranged from 0 to 7.02 cm3 (mean 0.98 ± 1.42 cm3). Pneumocephalus volumes were highly skewed with no air present after 44 (38.6%) lead implantations, >0 to 1 cm3 in 35 (30.7%), >2 to 3 cm3 in 17 (14.9%), and >3 cm3 (average 4.97 cm3) in 9 (7.9%). There was no incidence of clinically apparent VAE or symptomatic intracranial hemorrhage. There was no association between age, degree of atrophy, sagittal angle of surgical approach, number of microelectrode runs (MERs), distance of gyrus from inner skull bone at the entry point, or surgical side and pneumocephalus. However, the majority of lead implantations (100 leads; 88%) required only one MER and there were minimal measurable distances between entered gyrus and adjacent bone.


Our data suggest that strict supine positioning during STN DBS surgery results in minimal intracranial air and is not associated with VAE or symptomatic intracranial hemorrhage when the operative method described is used.


Deep brain stimulation Pneumocephalus Head positioning Subthalamic nucleus Venous air embolism Intracranial hemorrhage 



We thank Stanton Fernald, Cell Imaging Core, KUMC for assistance with graphics.

Conflicts of interest

Dr. Lyons is a consultant for St. Jude Medical and has been a consultant for Medtronic. Dr. Pahwa is a consultant for St. Jude Medical and Medtronic.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Jules M. Nazzaro
    • 1
    • 2
    • 3
    Email author
  • Kelly E. Lyons
    • 2
  • Robyn A. Honea
    • 2
  • Matthew S. Mayo
    • 4
  • Galen Cook-Wiens
    • 4
  • Amith Harsha
    • 2
  • Jeffrey M. Burns
    • 2
  • Rajesh Pahwa
    • 2
  1. 1.Department of NeurosurgeryUniversity of Kansas Medical CenterKansas CityUSA
  2. 2.Department of NeurologyUniversity of Kansas Medical CenterKansas CityUSA
  3. 3.Department of Molecular and Integrative PhysiologyUniversity of Kansas Medical CenterKansas CityUSA
  4. 4.Department of BiostatisticsUniversity of Kansas Medical CenterKansas CityUSA

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