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How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients

  • Original Article - Functional Neurosurgery - Other
  • Published:
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Abstract

Background

Accuracy of lead placement is the key to success in deep brain stimulation (DBS). Precise anatomic stereotactic planning usually is based on stable perioperative anatomy. Pneumocephalus due to intraoperative CSF loss is a common procedure-related phenomenon which could lead to brain shift and targeting inaccuracy. The aim of this study was to evaluate potential risk factors of pneumocephalus in DBS surgery.

Methods

We performed a retrospective single-center analysis in patients undergoing bilateral DBS. We quantified the amount of pneumocephalus by postoperative CT scans and corrected the data for accompanying brain atrophy by an MRI-based score. Automated computerized segmentation algorithms from a dedicated software were used. As potential risk factors, we evaluated the impact of trephination size, the number of electrode tracks, length of surgery, intraoperative blood pressure, and brain atrophy.

Results

We included 100 consecutive patients that underwent awake DBS with intraoperative neurophysiological testing. Systolic and mean arterial blood pressure showed a substantial impact with an inverse correlation, indicating that lower blood pressure is associated with higher volume of pneumocephalus. Furthermore, the length of surgery was clearly correlated to pneumocephalus.

Conclusion

Our analysis identifies intraoperative systolic and mean arterial blood pressure as important risk factors for pneumocephalus in awake stereotactic surgery.

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Funding

No funding was received for this research.

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Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675, Munich, Germany

    Philipp Krauss

  2. Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland

    Christiaan Hendrik Bas Van Niftrik, Pierre Scheffler, Markus Florian Oertel & Lennart Henning Stieglitz

  3. Clinical Neuroscience Center, University Hospital of Zurich, Zurich, Switzerland

    Christiaan Hendrik Bas Van Niftrik, Giovanni Muscas, Pierre Scheffler, Markus Florian Oertel & Lennart Henning Stieglitz

  4. Department of Neurosurgery, Careggi University Hospital Florence, Florence, Italy

    Giovanni Muscas

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Contributions

All authors confirm that the manuscript and the order of listed authors have been read and approved by all named authors.

PK: Conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft

BvN: Data curation, formal analysis, methodology, software, review and editing

GM: Data curation, formal analysis, investigation, methodology, software, review and editing

PS: Data curation, investigation, review and editing

MFO: Supervision, writing—review and editing

LHS: Supervision, writing—review and editing

Corresponding author

Correspondence to Philipp Krauss.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Kantonale Ethikkommision Zürich KEK) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Krauss, P., Van Niftrik, C.H.B., Muscas, G. et al. How to avoid pneumocephalus in deep brain stimulation surgery? Analysis of potential risk factors in a series of 100 consecutive patients. Acta Neurochir 163, 177–184 (2021). https://doi.org/10.1007/s00701-020-04588-z

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  • DOI: https://doi.org/10.1007/s00701-020-04588-z

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