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Titolo:
POSTOPERATIVE VENOUS AIR-EMBOLISM FOLLOWI NG PNEUMATOCEPHALUS - A RARE COMPLICATION INDICATING DISRUPTION OF A BRIDGING VEIN
Autore:
PAPADOPOULOS G; KUHLY P; BROCK M; RUDOLPH KH; LINK J; EYRICH K;
Indirizzi:
FREIEN UNIV BERLIN,KLINIKUM STEGLITZ,ANAESTHESIOL & OPERAT INTENS MEDKLIN,HINDENBURGDAMM 30 D-12203 BERLIN GERMANY FREE UNIV BERLIN,KLINIKUM STEGLITZ,NEUROCHIRURG KLIN & POLIKLIN W-1000 BERLIN 45 GERMANY
Titolo Testata:
Anasthesist
fascicolo: 9, volume: 42, anno: 1993,
pagine: 648 - 651
SICI:
0003-2417(1993)42:9<648:PVAFNP>2.0.ZU;2-3
Fonte:
ISI
Lingua:
GER
Soggetto:
POSTERIOR-FOSSA SURGERY; SITTING POSITION; TENSION PNEUMOCEPHALUS; ECHOCARDIOGRAPHY;
Keywords:
POSTERIOR FOSSA SURGERY; SITTING POSITION; PNEUMATOCEPHALUS; BRIDGING VEIN RUPTURE; POSTOPERATIVE AIR EMBOLISM;
Tipo documento:
Note
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
12
Recensione:
Indirizzi per estratti:
Citazione:
G. Papadopoulos et al., "POSTOPERATIVE VENOUS AIR-EMBOLISM FOLLOWI NG PNEUMATOCEPHALUS - A RARE COMPLICATION INDICATING DISRUPTION OF A BRIDGING VEIN", Anasthesist, 42(9), 1993, pp. 648-651

Abstract

Many neurosurgeons prefer the sitting position for patients undergoing surgery in the posterior fossa because of the easier access and better conditions for haemostasis. Pneumatocephalus is a possible consequence of surgery in the posterior fossa with the patient in the sitting position. When this occurs air may enter the subarachnoid space, the cisternae, the ventricular system or the subdural space; it becomes more likely when any of the following is/are present: loss of CSF, a large cavity resulting from surgery, external or internal drainage of CSF,osmotic diuresis, and hyperventilation. Distances of 1-2 cm between cranium and brain may be found. The rupture of bridging veins may causea subsequent subdural haematoma. Air embolism due to pneumatocephalusvia the same vein after closure of the cranium is in this paper for the first time. Case report. A 37-year-old man with known Hippel-Lindaudisease presented for posterior fossa surgery for treatment of a haemangioblastoma of the right cerebellar hemisphere. Surgery was done with the patient in a sitting position. Apart from one short episode of air embolism without haemodynamic changes no intraoperative complications occurred. After closure of the cranium and galea an unexpected and inexplicable air embolism of 10 min duration occurred again. TEE demonstrated the air looking like a string of beads in the right atrium. Ascomplete skin had already ready been closure no explanation for the air embolism could be found. The patient was positioned supine, and airwas no longer detectable in the right heart after 1 min. Approximately 1 h later both pupils were dilated and unreactive to light. Emergency CCT demonstrated a subdural haematoma above the right hemisphere as well as air in the ventricles and subdural space. Surgery revealed disruption of a large frontal bridging vein with direct access to the sagittal sinus as the origin of both the haematoma and the postoperative air embolism. Adjacent dura had prevented collapse of the bridging vein and continues to do so. We wish to point out that this complication of surgery in the sitting position may be more common than previously presumed. Conditions that may cause a pneumatocephalus must be given due consideration. A control CCT soon after completion of surgery may be advisable in cases where intracranial accumulation of air is expected. ICP monitoring via the ventricle catheter following placement of the patient in a supine position yields additional information about early postoperative cerebral haemorrhage and oedema.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/08/20 alle ore 17:46:18