Head positioning and risk of pneumocephalus, air embolism, and hemorrhage during subthalamic deep brain stimulation surgery

详细信息    查看全文

• 作者：Jules M. Nazzaro (1) (2) (3)
  Kelly E. Lyons (2)
  Robyn A. Honea (2)
  Matthew S. Mayo (4)
  Galen Cook-Wiens (4)
  Amith Harsha (2)
  Jeffrey M. Burns (2)
  Rajesh Pahwa (2)
  
• 关键词：Deep brain stimulation ; Pneumocephalus ; Head positioning ; Subthalamic nucleus ; Venous air embolism ; Intracranial hemorrhage
• 刊名：Acta Neurochirurgica
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：152
• 期：12
• 页码：2047-2052
• 全文大小：293KB
• 参考文献：1. Ashburner J, Friston KJ (2005) Unified segmentation. Neuroimage 26:839-51 mage.2005.02.018">CrossRef
  2. Benabid AL, Wallace B, Hoffmann D, Chabardes S, Grand S, LeBas JF (2008) Implantation of multiple electrodes and robotic techniques. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 126-39
  3. Burns JM, Cronk BB, Anderson HS, Donnelly JE, Thomas GP, Harsha A, Brooks WM, Swerdlow RH (2008) Cardiorespiratory fitness and brain atrophy in early Alzheimer disease. Neurology 71:210-16 CrossRef
  4. Daniluk S, Davies KG, Novak P, Vu T, Nazzaro JM, Ellias SA (2009) Isolation of the brain-related factor of the error between intended and achieved position of deep brain stimulation electrodes implanted into the subthalamic nucleus for the treatment of Parkinson’s disease. Neurosurgery 64:374-82 CrossRef
  5. Deogaonkar A, Avitsian R, Henderson JM, Schubert A (2005) Venous air embolism during deep brain stimulation surgery in an awake supine patient. Stereotact Funct Neurosurg 83:32-5 CrossRef
  6. Elias WJ, Fu KM, Frysinger RC (2007) Cortical and subcortical brain shift during stereotactic procedures. J Neurosurg 107:983-88 CrossRef
  7. Eller JL, Burchiel KJ (2008) Deep brain stimulation for tremor. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 153-65
  8. Goodman RR, Kim B, McClelland S III, Senatus PB, Winfield LM, Pullman SL, Yu Q, Ford B, McKhann GM (2006) Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:12-7 CrossRef
  9. Halpern CH, Danish SF, Baltuch GH, Jaggi JL (2008) Brain shift during deep brain stimulation surgery for Parkinson’s disease. Stereotact Funct Neurosurg 86:37-3 CrossRef
  10. Henderson JM (2008) Frameless functional stereotactic approaches. In: Bakay RAE (ed) Movement disorder surgery. Thieme, New York, pp 140-52
  11. Honea RA, Thomas GP, Harsha A, Anderson HS, Donnelly JE, Brooks WM, Burns JM (2009) Cardiorespiratory fitness and preserved medial temporal lobe volume in Alzheimer disease. Alzheimer Dis Assoc Disord 23:188-97 CrossRef
  12. Hooper AK, Okun MS, Foote KD, Haq IU, Fernandez HH, Hegland D, Robicsek SA (2009) Venous air embolism in deep brain stimulation. Stereotact Funct Neurosurg 87:25-0 CrossRef
  13. Hunsche S, Sauner D, Maarouf M, Lackner K, Sturm V, Treuer H (2007) Combined X-ray and magnetic resonance imaging facility: application to image-guided stereotactic and functional neurosurgery. Neurosurgery 60:352-60 CrossRef
  14. Hunsche S, Sauner D, Maarouf M, Poggenborg J, Lackner K, Sturm V, Treuer H (2009) Intraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes. Stereotact Funct Neurosurg 87:322-29 CrossRef
  15. Kenney C, Simpson R, Hunter C, Ondo W, Almaguer M, Davidson A, Jankovic J (2007) Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. J Neurosurg 106:621-25 CrossRef
  16. Khan MF, Mewes K, Gross RE, Skrinjar O (2008) Assessment of brain shift related to deep brain stimulation surgery. Stereotact Funct Neurosurg 86:44-3 CrossRef
  17. Miyagi Y, Shima F, Sasaki T (2007) Brain shift: an error factor during implantation of deep brain stimulation electrodes. J Neurosurg 107:989-97 CrossRef
  18. Moitra V, Permut TA, Penn RM, Roth S (2004) Venous air embolism in an awake patient undergoing placement of deep brain stimulators. J Neurosurg Anesthesiol 16:321-22 CrossRef
  19. Novak P, Klemp JA, Ridings LW, Lyons KE, Pahwa R, Nazzaro JM (2009) Effect of deep brain stimulation of the subthalamic nucleus upon the contralateral subthalamic nucleus in Parkinson disease. Neurosci Lett 463:12-6 CrossRef
  20. Rohlfing T, Maurer CR Jr, Dean D, Maciunas RJ (2003) Effect of changing patient position from supine to prone on the accuracy of a Brown–Roberts–Wells stereotactic head frame system. Neurosurgery 52:610-18 CrossRef
  21. Sansur CA, Frysinger RC, Pouratian N, Fu KM, Bittl M, Oskouian RJ, Laws ER, Elias WJ (2007) Incidence of symptomatic hemorrhage after stereotactic electrode placement. J Neurosurg 107:998-003 CrossRef
  22. Seijo FJ, Varez-Vega MA, Gutierrez JC, Fdez-Glez F, Lozano B (2007) Complications in subthalamic nucleus stimulation surgery for treatment of Parkinson’s disease. Review of 272 procedures. Acta Neurochir (Wien) 149:867-75 CrossRef
  23. Sierens D, Kutz S, Pilitsis JG, Bakay AE (2008) Stereotactic surgery with microelectrode recordings. In: Bakay RAE (ed) Movement disorders surgery. Thieme, New York, pp 83-14
  24. Suarez S, Ornaque I, Fabregas N, Valero R, Carrero E (1999) Venous air embolism during Parkinson surgery in patients with spontaneous ventilation. Anesth Analg 88:793-94 CrossRef
  25. Temel Y, Willbrink P, Duits A, Boon P, Tromp S, Ackermans L, van Kranen-Mastenbroek V, Weber W, Visser-Vandewalle V (2007) Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. Neurosurgery 61:ONS346–ONS357 CrossRef
  26. Videnovic A, Metman LV (2008) Deep brain stimulation for Parkinson’s disease: prevalence of adverse events and need for standardized reporting. Mov Disord 23:343-49 mds.21753">CrossRef
  27. Voges J, Waerzeggers Y, Maarouf M, Lehrke R, Koulousakis A, Lenartz D, Sturm V (2006) Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery—experiences from a single centre. J Neurol Neurosurg Psychiatry 77:868-72 CrossRef
  
• 作者单位：Jules M. Nazzaro (1) (2) (3)
  Kelly E. Lyons (2)
  Robyn A. Honea (2)
  Matthew S. Mayo (4)
  Galen Cook-Wiens (4)
  Amith Harsha (2)
  Jeffrey M. Burns (2)
  Rajesh Pahwa (2)
  
  1. Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, MS-3021, Kansas City, KS, 66160, USA
  2. Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
  3. Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
  4. Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
  

文摘

Purpose The objective of the present study was to evaluate the risk of pneumocephalus, venous air embolism (VAE), and intracranial hemorrhage in subthalamic nucleus (STN) deep brain stimulation (DBS) patients operated in the strict supine (head and body flat) position. Methods This was a retrospective review of clinical records and brain imaging of patients who underwent STN DBS between January 2007 and June 2009 at the University of Kansas Medical Center. Results A total of 61 patients underwent 114 lead implantations (53 staged bilateral and 8 unilateral). No case involved a transventricular route. Intracranial air volumes ranged from 0 to 7.02?cm3 (mean 0.98?±-.42?cm3). Pneumocephalus volumes were highly skewed with no air present after 44 (38.6%) lead implantations, >0 to 1?cm3 in 35 (30.7%), >2 to 3?cm3 in 17 (14.9%), and >3?cm3 (average 4.97?cm3) in 9 (7.9%). There was no incidence of clinically apparent VAE or symptomatic intracranial hemorrhage. There was no association between age, degree of atrophy, sagittal angle of surgical approach, number of microelectrode runs (MERs), distance of gyrus from inner skull bone at the entry point, or surgical side and pneumocephalus. However, the majority of lead implantations (100 leads; 88%) required only one MER and there were minimal measurable distances between entered gyrus and adjacent bone. Conclusions Our data suggest that strict supine positioning during STN DBS surgery results in minimal intracranial air and is not associated with VAE or symptomatic intracranial hemorrhage when the operative method described is used.