Venous air embolism in deep brain stimulation

Amanda K. Hooper, Michael S. Okun, Kelly D. Foote, Ihtsham U. Haq, Hubert H. Fernandez, Dustin Hegland, Steven A. Robicsek

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Background/Aims: During the placement of electrodes for deep brain stimulation (DBS), patients are commonly in a seated position, awake, and spontaneously breathing. Air may be entrained through bone or dural veins causing venous air emboli (VAE) and this phenomenon can result in significant hemodynamic changes. Although VAEs have been described in many types of neurosurgical procedures, their incidence during DBS surgery is unknown. Methods: Following approval from the Institutional Review Board, the University of Florida Movement Disorders Center database comprising 286 DBS leads placed since 2002 was reviewed. Intraoperative cough, which has been associated with VAE, as well as hemodynamic instability were the focus of the review. Additionally, a prospective evaluation of the incidence of VAE using precordial Doppler ultrasound was undertaken over a 3-month period (June 2007-August 2007). Results: The retrospective review revealed a 3.2% incidence of cough per lead. Prospective monitoring in 21 consecutive patients with 22 leads yielded the detection of 1 VAE, and an incidence of 4.5% per lead. Conclusion: VAEs are rare but potentially serious complications of DBS surgery unless recognized. Patient positioning and the occurrence of cough are two important predictors to consider in VAE. Precordial Doppler is a safe, non-invasive monitor that can be used in the early detection of VAE in these procedures.

Original languageEnglish (US)
Pages (from-to)25-30
Number of pages6
JournalStereotactic and Functional Neurosurgery
Volume87
Issue number1
DOIs
StatePublished - Feb 2009
Externally publishedYes

Keywords

  • Air embolism
  • Cough
  • Deep brain stimulation
  • Doppler ultrasound
  • Dystonia
  • Essential tremor
  • Parkinson's disease

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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