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Open Access 01-11-2020 | Air Embolism | Original Article - Tumor - Schwannoma

Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery

Authors: Kathrin Machetanz, Felix Leuze, Kristin Mounts, Leonidas Trakolis, Isabel Gugel, Florian Grimm, Marcos Tatagiba, Georgios Naros

Published in: Acta Neurochirurgica | Issue 11/2020

Abstract

Background

The semi-sitting position in neurosurgical procedures is still under debate due to possible complications such as venous air embolism (VAE) or postoperative pneumocephalus (PP). Studies reporting a high frequency of the latter raise the question about the clinical relevance (i.e., the incidence of tension pneumocephalus) and the efficacy of a treatment by an air replacement procedure.

Methods

This retrospective study enrolled 540 patients harboring vestibular schwannomas who underwent posterior fossa surgery in a supine (n = 111) or semi-sitting (n = 429) position. The extent of the PP was evaluated by voxel-based volumetry (VBV) and related to clinical predictive factors (i.e., age, gender, position, duration of surgery, and tumor size).

Results

PP with a mean volume of 32 ± 33 ml (range: 0–179.1 ml) was detected in 517/540 (96%) patients. The semi-sitting position was associated with a significantly higher PP volume than the supine position (40.3 ± 33.0 ml [0–179.1] and 0.8 ± 1.4 [0–10.2], p < 0.001). Tension pneumocephalus was observed in only 14/429 (3.3%) of the semi-sitting cases, while no tension pneumocephalus occurred in the supine position. Positive predictors for PP were higher age, male gender, and longer surgery duration, while large (T4) tumor size was established as a negative predictor. Air exchange via a twist-drill was only necessary in 14 cases with an intracranial air volume > 60 ml. Air replacement procedures did not add any complications or prolong the ICU stay.

Conclusion

Although pneumocephalus is frequently observed following posterior fossa surgery in semi-sitting position, relevant clinical symptoms (i.e., a tension pneumocephalus) occur in only very few cases. These cases are well-treated by an air evacuation procedure. This study indicates that the risk of postoperative pneumocephalus is not a contraindication for semi-sitting positioning.

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Title: Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery
Authors: Kathrin Machetanz
Felix Leuze
Kristin Mounts
Leonidas Trakolis
Isabel Gugel
Florian Grimm
Marcos Tatagiba
Georgios Naros
Publication date: 01-11-2020
Publisher: Springer Vienna
Keywords: Air Embolism
Vestibular Schwannoma
Vestibular Schwannoma
Published in: Acta Neurochirurgica / Issue 11/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-020-04504-5

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Springer Medicine

Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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