Objective: 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 utilize the semi-sitting position.

Background: The semi-sitting position, however, carries an inbound risk of venous air embolism. Here we analyze the occurrence and management of this complication in a large consecutive series of patients.

Method: We performed a retrospective analysis in a series of 634 functional stereotactic operations in the semi-sitting position. Surgery was performed while the patient were awake in 567 instances. Any clinical signs for air embolism such as increased throat clearing, coughing and circulatory problems were scrutinized.

Results: 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). There were several instances of increased throat clearing and slight coughing 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 a cervical dystonia. All three patients were circulatory 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.

Conclusion: Stereotactic functional surgery in a semi-sitting is a generally safe procedure with a low risk for intraoperative venous air embolism. Immediate reaction to the signs of venous air embolism allow the procedure to be completed.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intraoperative-venous-air-embolism-in-the-semi-sitting-position-in-functional-neurosurgery/