Esophageal tear in a patient undergoing stereotactic brain biopsy under general anesthesia

Abstract

Injuries of the esophagus with resultant mediastinitis have been reported following endotracheal intubation. Herein, we report a case of esophageal perforation that resulted from difficulty with intubation in a patient with a stereotactic head frame. A 52-year-old woman underwent a stereotactic brain biopsy of a left temporal tumor. After a stereotactic head frame was applied, intubation for anesthesia required three attempts. On postoperative day 2, she complained of worsening dysphagia and chest pain. A 4-mm tear in the right posterior cervical esophagus was discovered and repaired. Esophageal perforation may arise from limited neck extension imposed by a stereotactic head frame. Unexplained dysphagia postoperatively is the hallmark of this rare complication.

Efficacy and Safety of Local Versus General Anesthesia in Stereotactic Biopsies

“…2,5,7 However, there is no consensus on whether or when to use LA or GA. 10 In contrast, authors indicate that GA might prevent intraoperative seizures in patients with a history of epilepsy 11 or indicate the use of GA in patients presenting with a history of seizures. Several advantages and drawbacks for both the anesthetic techniques have been reported.…”

“…Some centers prefer mainly GA or mainly LA for stereotactic procedures. 10 The prone position and brain stem lesions may be considered as contraindications for LA because of the limited airway access. The use of LA may reduce the risk of cardiac and pulmonary complications and may lead to shorter procedure duration and shorter postoperative recovery times.…”

Airway Management with Leksell Frame in situ with or without Frontal Bar: A Mannequin Study

“…However, previous case reports have reported potential problems associated with airway management including failed insertion of intubating laryngeal mask airway (iLMA) and esophageal perforation following multiple intubation attempts. 2,3 Therefore, it has always been suggested to keep an Allen wrench with the patient to remove the frame in emergency situations where intubation or LMA insertion is not successful. 3 Recently, newer procedures such as SEEG and magnetic resonance imaging-guided laser interstitial thermal therapy (MRIgLITT) may require special configurations of the standard stereotactic frame (Leksell G series frame, Elekta, Stolkhom, Sweden).…”

Emergency tracheal intubation through intubating laryngeal mask airway in patients with stereotactic frame in situ

“…Intubation techniques using a light wand or gum elastic bougie might allow easy passage of the tube without direct visualisation of the glottis, but not without complications. [ 2 ] A supraglottic airway device for airway management and an Allen wrench for removal of the crossbar must be immediately available if intubation proves unsuccessful.…”