Abstract
Background
Venous air embolism (VAE) is a serious potential complication of neurosurgical procedures. Stereotactic biopsies can also cause VAE; therefore, we evaluated VAE patients to call attention to the risk of VAE associated with stereotactic biopsies.
Methods
In this report, symptomatic VAE was defined as paroxysmal coughing with associated symptoms. Air in the dural sinus, cortical vein and/or pterygoid plexus on postoperative computed tomography (CT) scans was considered to be a radiographic VAE.
Results
Three patients developed symptomatic VAE following 36 stereotactic biopsies, and the incidence of symptomatic VAE was 8.3 % (3/36). There were five patients with evidence of radiographic VAE on postoperative CT scans, with an incidence of 13.8 % (5/36). A high angle of the head seemed to be associated with VAE, allowing air to flow into the central venous system.
Conclusions
The present report emphasizes that VAE should be recognized as an important adverse effect of stereotactic biopsies because VAE occasionally requires additional treatment and/or termination of surgery. Surgeons must be aware of the possibility of VAE, especially when it is necessary to position the patient’s head at a high angle.
References
Adams M, Quint DJ, Eldevik OP (1992) Iatrogenic air in the cavernous sinus. AJR Am J Roentgenol 159:189–190
Balki M, Manninen PH, McGuire GP, El-Beheiry H, Bernstein M (2003) Venous air embolism during awake craniotomy in a supine patient. Can J Anaesth 50:835–838
Bartynski WS, Wang AM (1998) Cavernous sinus air in a patient with basilar skull fracture: CT identification. J Comput Assist Tomogr 12:141–142
Black S, Ockert DB, Oliver WC Jr, Cucchiara RF (1998) Outcome following posterior fossa craniectomy in patients in the sitting or horizontal positions. Anesthesiology 69:49–56
Cabezudo JM, Gilsanz F, Vaquero J, Areitio E, Martinez R (1981) Air embolism from wounds from a pin-type head-holder as a complication of posterior fossa surgery in the sitting position. Case report. J Neurosurg 55:147–148
Chang EF, Cheng JS, Richardson RM, Lee C, Starr PA, Larson PS (2011) Incidence and management of venous air embolisms during awake deep brain stimulation surgery in a large clinical series. Stereotact Funct Neurosurg 89:76–82
Deogaonkar A, Avitsian R, Henderson JM, Schubert A (2005) Venous air embolism during deep brain stimulation surgery in an awake supine patient. Stereotact Funct Neurosurg 83:32–35
Faberowski LW, Black S, Mickle JP (2000) Incidence of venous air embolism during craniectomy for craniosynostosis repair. Anesthesiology 92:20–23
Frost EA (1984) Some inquiries in neuroanesthesia and neurological supportive care. J Neurosurg 60:673–686
Grinberg F, Slaughter TF, McGrath BJ (1995) Probable venous air embolism associated with removal of the Mayfield skull clamp. Anesth Analg 80:1049–1050
Grossman R, Sadetzki S, Spiegelmann R, Ram Z (2005) Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies. Acta Neurochir (Wien) 147:627–631
Hooper AK, Okun MS, Foote KD, Haq IU, Fernandez HH, Hegland D, Robicsek SA (2009) Venous air embolism in deep brain stimulation. Stereotact Funct Neurosurg 87:25–30
Jadik S, Wissing H, Friedrich K, Beck J, Seifert V, Raabe A (2009) A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery 64:533–538
Kuno R, Robertson WD (1995) Cavernous sinus air following orbital trauma. AJR Am J Roentgenol 164:980
McGirt MJ, Woodworth GF, Coon AL, Frazier JM, Amundson E, Garonzik I, Olivi A, Weingart JD (2005) Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases. J Neurosurg 102:897–901
Nazzaro JM, Lyons KE, Honea RA, Mayo MS, Cook-Wiens G, Harsha A, Burns JM, Pahwa R (2010) Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery. Acta Neurochir (Wien) 152:2047–2052
Palmon SC, Moore LE, Lundberg J, Toung T (1997) Venous air embolism: a review. J Clin Anesth 9:251–257
Rubinstein D, Dangleis K, Damiano TR (1996) Venous air emboli identified on head and neck CT scans. J Comput Assist Tomogr 20:559–562
Rubinstein D, Symonds D (1994) Gas in the cavernous sinus. AJNR Am J Neuroradiol 15:561–566
Sawin PD, Hitchon PW, Follett KA, Torner JC (1998) Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases. Surg Neurol 49:640–649
Standefer M, Bay JW, Trusso R (1984) The sitting position in neurosurgery: a retrospective analysis of 488 cases. Neurosurgery 14:649–658
Stone JG, Schwartz AE, Berman MF, Lenczewski VS, Ahmad SM, Bruce JN, Goodman RR (1997) Air embolization in seated, sedated, spontaneously breathing, neurosurgical patients. Anesthesiology 87:1244–1247
Suarez S, Ornaque I, Fábregas N, Valero R, Carrero E (1999) Venous air embolism during Parkinson surgery in patients with spontaneous ventilation. Anesth Analg 88:793–794
Swartz MA, Munz M, Stern MB (1997) Respiratory failure following stereotactic neurosurgery in a 53-year-old woman. Chest 111:1112–1114
Tobias JD, Johnson JO, Jimenez DF, Barone CM, McBride DS Jr (2001) Venous air embolism during endoscopic strip craniectomy for repair of craniosynostosis in infants. Anesthesiology 95:340–342
Warnick RE, Longmore LM, Paul CA, Bode LA (2003) Postoperative management of patients after stereotactic biopsy: results of a survey of the AANS/CNS section on tumors and a single institution study. J Neurooncol 62:289–296
Young ML, Smith DS, Murtagh F, Vasquez A, Levitt J (1986) Comparison of surgical and anesthetic complications in neurosurgical patients experiencing venous air embolism in the sitting position. Neurosurgery 18:157–161
Zickler P, Hartung HP, Janssen H (2009) ‘Bubbles in the brain’: retrograde venous air embolism in the cavernous sinus. Eur Neurol 61:318
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ooba, H., Abe, T., Momii, Y. et al. Venous air embolism (VAE) associated with stereotactic biopsies. Acta Neurochir 156, 433–437 (2014). https://doi.org/10.1007/s00701-013-1903-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-013-1903-x