Venous Air Embolism in Sitting and Supine Patients Undergoing Vestibular Schwannoma Resection

Duke, Derek A.; Lynch, James J.; Harner, Stephen G.; Faust, Ronald J.; Ebersold, Michael J.

doi:10.1097/00006123-199806000-00047

Cited by 79 publications

(37 citation statements)

References 23 publications

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“…Nonetheless, surgeon's preference and familiarity with a particular position is most important. 5 We avoid the supine position due to the risk of neck stiffness associated with such long operative sessions. Our preference has been the park-bench position.…”

Section: Patient Positioningmentioning

confidence: 99%

Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success

Kulwin

Cohen-Gadol

2012

FOC

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Removal of vestibular schwannomas (VSs, or acoustic neuromas) remains one of the most challenging operations in neurosurgery. Giant or huge tumors (> 5 cm) heighten these challenges, and technical nuances play a special role in maximizing tumor resection while minimizing complications. In this article, the senior author describes his technical experience with microsurgical excision of giant VSs. The accompanying video further illustrates these details.

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Section: Patient Positioningmentioning

confidence: 99%

Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success

Kulwin

Cohen-Gadol

2012

FOC

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“…The most feared complication of this position is venous air embolism. Air embolism may occur in any operation with an open vein and a gradient of venous pressure between the surgical site and the heart [8][9][10][11][12] . The incidence in the horizontal position is, however, lower.…”

Section: Discussionmentioning

confidence: 99%

“…Series comparing the prognosis of patients operated on in sitting and horizontal position, conclude that despite the venous air embolism being an important factor in surgery of posterior cranial fossa, the current methods of monitoring allow an early detection and prompt therapy of venous air embolism 12,23 . Nevertheless, we have to consider that not all departments have such modern methods of monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…This position permits drainage of blood and cerebrospinal fluid (CSF) allowing a better visualization and dissection of the cranial nerves, easier hemostasia and reduces venous bleeding. The main disadvantages of this position are the increased risk of venous air embolism and hemodynamic instability, especially in elderly patients [8][9][10][11][12] . The aim of this study was to evaluate the results of surgical treatment of VS in patients operated on through the retrosigmoid-transmeatal approach, in the dorsal decubitus position (mastoid position).…”

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confidence: 99%

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Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

Cardoso

Fernandes

Ramina

et al. 2007

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). Method: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7 th and 8 th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Results: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Conclusion: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.KEY WORDS: acoustic neuroma, vestibular schwannoma, mastoid position, venous air embolism.Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal RESUMO -Objetivo: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). Método: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. Resultados: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. Conclusão: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade. PALAVRAS-CHAVE: neurinoma do acústico, schwannoma vestibular, posição de mastóide, embolia gasosa.

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“…16 The incidence of neurosurgical skull base VAE in any head-elevated position has been noted to be 28% for sitting craniotomies compared with 5% for supine and prone positions. 7 Because many skull base resections involve the jugular vein and cavernous or sigmoid sinuses, and considering that some positioning requires slight head elevation, the risk of passive air entrainment is increased. With the transtemporal and transcochlear approaches to the skull base, the patient is supine and the surgical field is neutral to the heart.…”

Section: Patient Positioningmentioning

confidence: 99%

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

Jellish¹,

Murdoch²,

Jp³

2002

FOC

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The anesthetic management of complex skull base surgical procedures provides unique problems and concerns for the neuroanesthesiologist. Positioning to access the skull base could put the patient at risk for peripheral nerve injury and some of the positions may increase the risk for air emboli. In addition, tumor pathology and involvement with vital structures could increase the chances for substantive blood loss, destruction of associated nerves or vessels, and may require temporary occlusion of the carotid artery necessitating intraoperative neuroprotection. Neurophysiological monitors may also be used to safeguard nerve function and anesthetic techniques must be adjusted to accommodate their use. Finally, postoperative morbidity may be affected by surgical approach to the skull base and the anesthesiologist should be aware of which approach may produce a greater incidence of pain, nausea, and vomiting in the postoperative period. The authors discuss the anesthetic concerns and management for complex cranial base surgery. Different approaches will be discussed and comparisons of perioperative parameters between these approaches will be made with data provided by retrospective chart review of more than 600 skull base procedures performed at the authors' institution over the last 10 years. This information should help guide decision making concerning anesthetic management for these skull base procedures.

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Venous Air Embolism in Sitting and Supine Patients Undergoing Vestibular Schwannoma Resection

Abstract: Our results indicate that although there is a higher incidence of VAE detection in sitting patients, the morbidity is not statistically greater. We conclude that because morbidity from VAE is similar in either position, patient positioning should be based on surgical team preference.

Cited by 79 publications

References 23 publications

Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success

Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

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