Venous air embolism in deep brain stimulation.

Area of Science:

• Neurosurgery
• Medical Devices
• Patient Safety

Background:

• Deep brain stimulation (DBS) surgery often involves patients in a seated, awake position, increasing the risk of venous air emboli (VAE) through entrained air.
• VAE can cause significant hemodynamic changes, but their incidence during DBS procedures remains unknown.
• VAE have been documented in various neurosurgical operations.

Purpose of the Study:

• To determine the incidence of venous air emboli (VAE) during deep brain stimulation (DBS) surgery.
• To identify potential predictors of VAE during DBS procedures.
• To evaluate the utility of precordial Doppler ultrasound for VAE detection in DBS.

Main Methods:

• A retrospective review of 286 DBS leads placed since 2002 at the University of Florida Movement Disorders Center.
• Analysis focused on intraoperative cough and hemodynamic instability as indicators of VAE.
• Prospective evaluation of VAE incidence using precordial Doppler ultrasound in 21 patients over a 3-month period.

Main Results:

• Retrospective review indicated a 3.2% incidence of cough per DBS lead.
• Prospective monitoring detected 1 VAE in 22 leads, resulting in an incidence of 4.5% per lead.
• The study identified patient positioning and cough as potential VAE predictors.

Conclusions:

• Venous air emboli (VAE) are infrequent but serious complications in DBS surgery that require recognition.
• Patient positioning and intraoperative cough are key predictors to consider for VAE.
• Precordial Doppler ultrasound offers a safe, non-invasive method for early VAE detection during DBS procedures.