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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

The intraoperative monitoring of venous air embolism using TEE in patients undergoing neurosurgical intervention in the semi-sitting position and a review of the literature

Intraoperatives Monitoring der venösen Luftembolie mittels TEE bei Patienten, die in der halb-sitzenden Position neurochirurgisch operiert werden und Literaturübersicht

Meeting Abstract

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  • corresponding author S. Jadik - Neurochirurgische Klinik, Universitätsklinikum Frankfurt am Main
  • A. Raabe - Neurochirurgische Klinik, Universitätsklinikum Frankfurt am Main
  • V. Seifert - Neurochirurgische Klinik, Universitätsklinikum Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP049

The electronic version of this article is the complete one and can be found online at:

Published: May 4, 2005

© 2005 Jadik et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Infratentorial craniotomies may be performed in the semi-sitting position if a patent foramen ovale is excluded. The major complications reported in the literature are venous air embolism and prolonged ICU course with extended extubation time. We evaluated the patient data to asses the incidence and severity of VAE and other major complications using a protocol with standardized positioning and transesophageal echocardiographic monitoring during the intervention.


187 Patients were operated in the semi-sitting position between 1999 and 2004 and were monitored intraoperatively using a transesophageal echocardiographic examination. The data were collected retrospectively from the charts of the patients for the incidence of air embolism and other complications related to positioning.


The mean age of the patients was 51,4 (±16,4) y, the mean operation time was 4,3 (±1,9) hours. Only 3 (1,6%) cases of venous air embolism occurred and air could be aspired from the central line in 187 patients. Only one case was hemodynamically relevant with temporary arterial blood pressure decrease and heart rate increase. Pneumatocephalus leading to lethargy was a frequent postoperative finding, which resolved spontaneously without morbidity. One case with an epileptic seizure and N. III affection due to subdural trapped air had to be treated surgically. There was no permanent morbidity or mortality in our study related to the semi-sitting position.


Using transesophageal echocardiografic monitoring and a standardized positioning, posterior fossa craniotomies in the semi-sitting position can be performed safely.