title: Incidence and management of venous air embolisms during awake deep brain stimulation surgery in a large clinical series.
abstract: OBJECTIVE
  Venous air embolism (VAE) is a potential complication during neurosurgical procedures, particularly in the sitting position. The diagnosis and management of VAE in patients undergoing awake deep brain stimulation (DBS) lead implantation in the sitting position are underreported.
  
  
  METHODS
  We performed a retrospective chart review of 467 consecutive DBS surgeries at the University of California, San Francisco. Data was collected for patient demographics, diagnosis, intraoperative events, and postoperative course.
  
  
  RESULTS
  Six cases of clinically diagnosed VAE were found, amounting to a total incidence of 1.3% per procedure. We did not observe a statistical association with patient age, diagnosis, or DBS target. The most common symptoms of intraoperative VAE were coughing, oxygen desaturation, and hypotension. In all cases, VAE was treated by copious irrigation of the surgical field and lowering the patient's head. In 4 cases, DBS implantation was abandoned because of ongoing symptoms of VAE. The respiratory outcome in all patients was good after several days of close observation.
  
  
  CONCLUSIONS
  The incidence of VAE during DBS procedures is small, but prompt recognition and management of VAE are critical to avoid further associated complications.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA. changed@neurosurg.ucsf.edu
authors.forename: Edward F
authors.initials: EF
authors.lastname: Chang
authors.forename: Jason S
authors.initials: JS
authors.lastname: Cheng
authors.forename: R Mark
authors.initials: RM
authors.lastname: Richardson
authors.forename: Chanhung
authors.initials: C
authors.lastname: Lee
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
authors.forename: Paul S
authors.initials: PS
authors.lastname: Larson
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004421:Dystonia / Q000628:therapy*; D004618:Embolism, Air / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010300:Parkinson Disease / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016683:Supine Position; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014680:Veins