Venous air embolism (VAE) associated with stereotactic biopsies

Venous air embolism (VAE) is a serious potential complication of neurosurgical procedures. Stereotactic biopsies can also cause VAE; therefore, we evaluated VAE patients to call attention to the risk of VAE associated with stereotactic biopsies. In this report, symptomatic VAE was defined as paroxysmal coughing with associated symptoms. Air in the dural sinus, cortical vein and/or pterygoid plexus on postoperative computed tomography (CT) scans was considered to be a radiographic VAE. Three patients developed symptomatic VAE following 36 stereotactic biopsies, and the incidence of symptomatic VAE was 8.3 % (3/36). There were five patients with evidence of radiographic VAE on postoperative CT scans, with an incidence of 13.8 % (5/36). A high angle of the head seemed to be associated with VAE, allowing air to flow into the central venous system. The present report emphasizes that VAE should be recognized as an important adverse effect of stereotactic biopsies because VAE occasionally requires additional treatment and/or termination of surgery. Surgeons must be aware of the possibility of VAE, especially when it is necessary to position the patient's head at a high angle.