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Durmuş YE, Kaval B, Demirgil BT, Gökalp E, Gurses ME, Varol E, Gonzalez-Lopez P, Cohen-Gadol A, Gungor A. Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series. Oper Neurosurg (Hagerstown) 2023; 25:103-111. [PMID: 37255298 DOI: 10.1227/ons.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND It has always been a matter of debate which position is ideal for the supracerebellar approach. The risk of venous air embolism (VAE) is the major deterrent for surgeons and anesthesiologists, despite the fact that sitting and semisitting positions are commonly used in these operations. OBJECTIVE To demonstrate a reduction on the risk of VAE and tension pneumocephalus throughout the operation period while taking advantages of the semisitting position. METHODS In this study, 11 patients with various diagnoses were operated in our department using the supracerebellar approach in the dynamic lateral semisitting position. We used end-tidal carbon dioxide and arterial blood pressure monitoring to detect venous air embolism. RESULTS None of the patients had clinically significant VAE in this study. No tension pneumocephalus or major complications were observed. All the patients were extubated safely after surgery. CONCLUSION The ideal position, with which to apply the supracerebellar approach, is still a challenge. In our study, we presented an alternative position that has advantages of the sitting and semisitting positions with a lower risk of venous air embolism.
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Affiliation(s)
- Yunus Emre Durmuş
- Department of Neurosurgery, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Barış Kaval
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Bülent Timur Demirgil
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Elif Gökalp
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Eyüp Varol
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, İstanbul, Turkey
| | - Pablo Gonzalez-Lopez
- Department of Neurosurgery, General University Hospital Alicante, Alicante, Spain
| | - Aaron Cohen-Gadol
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- The Neurosurgical Atlas, Carmel, Indianapolis, Indiana, USA
| | - Abuzer Gungor
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
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Khouri D, Delgado M, Lemes J, Afonso Cruz M. Differential diagnosis of intraoperative cardiac arrest after spine surgery in prone position. Saudi J Anaesth 2022; 16:485-487. [PMID: 36337392 PMCID: PMC9630707 DOI: 10.4103/sja.sja_893_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
Intraoperative cardiac arrest is one of the most feared events by anesthesiologists and surgeons. Although there are many possible causes, three differential diagnoses stand out in the presented scenario: pulmonary embolism, gas embolism, and acute myocardial infarction. A 61-year-old female patient was admitted in the hospital to C2-C5 arthrodesis. Despite no major bleeding during surgery, immediately after supination the patient developed refractory hypotension, a decrease in end tidal CO2, progressive bradycardia that ultimately led to pulseless electrical activity. Resuscitation maneuvers were promptly performed, sustained return of spontaneous circulation was attained after 50 minutes, and the patient was transferred to the ICU. This paper discusses the main causes for an episode of cardiac arrest in the context of cervical arthrodesis, with a markedly prolonged resuscitation time, in which the patient survived.
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Javed K, Hamad MK, Holland R, Fortunel AN, Ammar A, Cezayirli PC, Haranhalli N, Altschul DJ. Use of the Image Guided Minimally Invasive BrainPath System to Evacuate Spontaneous Cerebellar Hemorrhages. Cureus 2021; 13:e16124. [PMID: 34350083 PMCID: PMC8325984 DOI: 10.7759/cureus.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
BrainPath (NICO, Indianapolis, Indiana) is a tool that can be used to evacuate supratentorial hematomas due to spontaneous intracerebral hemorrhage (ICH). However, when ICH occurs in the posterior fossa, an open approach is often undertaken to evacuate the hematoma. The application of minimally invasive technology, while available, has not been well established. Our objective was to describe the use of the image-guided, minimally invasive BrainPath system to evacuate a spontaneous cerebellar hemorrhage. We present the case of a sixty-four-year-old male patient with a cerebellar hematoma due to hypertensive hemorrhage. The patient's medical record, including the history and physical, progress notes, operative notes, discharge summary, and imaging studies were reviewed to document the clinical presentation as well as the details of the operative technique and postoperative outcomes in this paper. We discuss the technical nuances of the operative points in detail. In our example case, the BrainPath system was successfully used to evacuate the cerebellar hematoma and no procedural-related complications occurred. The patient's recovery remained uncomplicated at three months of follow-up. In summary, the BrainPath system offers a less invasive alternative to open evacuation for cerebellar bleeds.
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Affiliation(s)
- Kainaat Javed
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Mousa K Hamad
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Ryan Holland
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Adisson N Fortunel
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Adam Ammar
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Phillip C Cezayirli
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - Neil Haranhalli
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
| | - David J Altschul
- Neurological Surgery, Montefiore Medical Center, Moses Campus, New York, USA
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Yeung E, Adeboye A, Granet P, Casos S. Rare pathology in a trauma patient: air embolism following peripheral intravenous access. BMJ Case Rep 2021; 14:14/1/e240428. [PMID: 33509893 PMCID: PMC7845703 DOI: 10.1136/bcr-2020-240428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant's manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.
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Affiliation(s)
- Enoch Yeung
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Adeolu Adeboye
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Paul Granet
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Steven Casos
- Surgery, Guthrie Robert Packer Hospital, Sayre, Pennsylvania, USA
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Rahmani R, Susa ST, Sandwell SE, Kimmell KT, Maurer PK, Silberstein HJ, Nadler JW, Walter KA. Perioperative Risk of the Sitting Position for Elective Posterior Cervical Spine Surgery: A Retrospective Case Series. NEUROSURGERY OPEN 2020. [DOI: 10.1093/neuopn/okaa009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
BACKGROUND
The sitting cervical position for elective posterior cervical decompression and fusion affords advantages over prone positioning, but remains unpopular due to concerns about venous air embolism (VAE).
OBJECTIVE
To demonstrate the safety and efficacy of sitting cervical surgery in our series and in the literature.
METHODS
To evaluate the incidence of complications, we retrospectively identified all adult patients who underwent elective sitting posterior cervical surgeries at our institution from 2009 to 2014. Using International Classification of Diseases-9 coding, we searched for incidences of air embolism, myocardial infarction, pulmonary embolism, and deep vein thrombosis. Operative time, estimated blood loss, and case type distribution were also recorded. We then calculated the incidence of clinically significant VAE in sitting cervical surgeries.
RESULTS
Between 2009 and 2014, 558 surgeries were performed in the sitting cervical position. No VAE was identified. The average operative time was 1 h 25 min. A total of 30-d perioperative complications among sitting position patients included 3 myocardial infarctions, 1 pulmonary embolism attributed to venous thrombosis, and 2 patients with deep venous thrombosis for a total cardiovascular complication rate of 1.1%. The incidence of clinically significant VAE in the literature is 1.5%.
CONCLUSION
We present the second largest case series to date on the sitting position for cervical surgeries, highlighting its safety and efficacy. This position provides a surgical field with superior visualization, allowing decreased operative time and blood loss. The risk of clinically significant VAE is low. Intraoperative monitoring for these events with less invasive means is safe and effective.
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Affiliation(s)
- Redi Rahmani
- Department of Neurosurgery, University of Rochester, Rochester, New York
| | - Stephen T Susa
- Department of Neurosurgery, University of Rochester, Rochester, New York
| | | | | | - Paul K Maurer
- Department of Neurosurgery, Unity Hospital, Rochester, New York
| | | | - Jacob W Nadler
- Department of Anesthesiology, University of Rochester, Rochester, New York
| | - Kevin A Walter
- Department of Neurosurgery, University of Rochester, Rochester, New York
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Vinan-Vega MN, Rahman MR, Thompson J, Ruppert MD, Patel RJ, Ismail A, Mousa S, Payne JD. Air embolism following peripheral intravenous access. Proc (Bayl Univ Med Cent) 2019; 32:433-434. [PMID: 31384213 DOI: 10.1080/08998280.2019.1609154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 01/04/2023] Open
Abstract
Air embolism is a rare, often misdiagnosed, potentially fatal condition. It is most frequently associated with invasive vascular procedures and mechanical ventilation. Air emboli developing from peripheral intravenous lines are uncommon. We present a case of symptomatic venous air embolism likely arising from peripheral intravenous access gained during an interventional pain procedure. This case highlights the need to consider air embolism in the differential diagnoses of patients presenting with neurological symptoms following vascular interventions.
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Affiliation(s)
| | - M Rubayat Rahman
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Jeremy Thompson
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Misty D Ruppert
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Raj J Patel
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Amr Ismail
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Sara Mousa
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - J Drew Payne
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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Miyakoshi N, Hongo M, Kasukawa Y, Ishikawa Y, Kudo D, Shimada Y. Intraoperative Visible Air Bubbling Recorded as a Sign of Massive Venous Air Embolism During Prone Position Surgery for Extensive Ossification of Spinal Ligaments: A Case Report with a Video Clip. World Neurosurg 2019; 131:38-42. [PMID: 31369880 DOI: 10.1016/j.wneu.2019.07.166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/23/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Venous air embolism (VAE) is a rare but, frequently, fatal complication that can occur during surgery. Several reported studies have shown visible bubbling of air at the surgical site as the first clinical indication of VAE-induced cardiovascular collapse during prone-position spine surgery. However, to the best of our knowledge, video imaging of this phenomenon has not been previously reported. CASE DESCRIPTION A 41-year-old man had undergone cervical laminoplasty for ossification of the posterior longitudinal ligament and thoracic laminectomy for ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum in the prone position. The entire surgery was recorded with video imaging. Before cardiac arrest due to the massive VAE, visible air bubbling had been observed at the operated site of the thoracic laminectomy, and this phenomenon had been incidentally recorded with the video. The patient recovered with cardiopulmonary resuscitation and intensive treatment against severe acute respiratory distress syndrome due to pulmonary damage. CONCLUSIONS The present case report offers the first video imaging evidence of intraoperative visible air bubbling as a sign of a massive VAE during prone-position spine surgery. To the best of our knowledge, this is also the first report of intraoperative VAE in a patient with extensive ossification of the spinal ligaments.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshinori Ishikawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daisuke Kudo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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