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Acta Neurochirurgica
Published in: Acta Neurochirurgica 12/2010

01-12-2010 | Clinical Article

Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery

Authors: Jules M. Nazzaro, Kelly E. Lyons, Robyn A. Honea, Matthew S. Mayo, Galen Cook-Wiens, Amith Harsha, Jeffrey M. Burns, Rajesh Pahwa

Published in: Acta Neurochirurgica | Issue 12/2010

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.
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Metadata
Title
Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery
Authors
Jules M. Nazzaro
Kelly E. Lyons
Robyn A. Honea
Matthew S. Mayo
Galen Cook-Wiens
Amith Harsha
Jeffrey M. Burns
Rajesh Pahwa
Publication date
01-12-2010
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 12/2010
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-010-0776-5

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