Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery
- 411 Downloads
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.
KeywordsDeep 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.
- 2.Benabid AL, Wallace B, Hoffmann D, Chabardes S, Grand S, LeBas JF (2008) Implantation of multiple electrodes and robotic techniques. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 126–139Google Scholar
- 4.Daniluk S, Davies KG, Novak P, Vu T, Nazzaro JM, Ellias SA (2009) Isolation of the brain-related factor of the error between intended and achieved position of deep brain stimulation electrodes implanted into the subthalamic nucleus for the treatment of Parkinson’s disease. Neurosurgery 64:374–382CrossRefPubMedGoogle Scholar
- 7.Eller JL, Burchiel KJ (2008) Deep brain stimulation for tremor. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 153–165Google Scholar
- 8.Goodman RR, Kim B, McClelland S III, Senatus PB, Winfield LM, Pullman SL, Yu Q, Ford B, McKhann GM (2006) Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:12–17CrossRefPubMedGoogle Scholar
- 10.Henderson JM (2008) Frameless functional stereotactic approaches. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 140–152Google Scholar
- 14.Hunsche S, Sauner D, Maarouf M, Poggenborg J, Lackner K, Sturm V, Treuer H (2009) Intraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes. Stereotact Funct Neurosurg 87:322–329CrossRefPubMedGoogle Scholar
- 23.Sierens D, Kutz S, Pilitsis JG, Bakay AE (2008) Stereotactic surgery with microelectrode recordings. In: Bakay RAE (ed) Movement disorders surgery. Thieme, New York, pp 83–114Google Scholar
- 25.Temel Y, Willbrink P, Duits A, Boon P, Tromp S, Ackermans L, van Kranen-Mastenbroek V, Weber W, Visser-Vandewalle V (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery 61:ONS346–ONS357CrossRefGoogle Scholar