title: Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurosurgery, University of Kansas Medical Center, Kansas City, 66160, USA. jnazzaro@kumc.edu
authors.forename: Jules M
authors.initials: JM
authors.lastname: Nazzaro
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Lyons
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Honea
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Mayo
authors.forename: Galen
authors.initials: G
authors.lastname: Cook-Wiens
authors.forename: Amith
authors.initials: A
authors.lastname: Harsha
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Burns
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pahwa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D004618:Embolism, Air / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D056888:Patient Positioning / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011007:Pneumocephalus / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000601:surgery*