Monitoring of intracranial venous sinus pressure and prevention for venous air embolism during operation with semi-sitting position

Abstract

BackgroundVenous air embolism (VAE) during craniotomy operation with semi-sitting position is closely related to intracranial venous pressure. The objective of current study was to explore the relationship between intracranial venous pressure and VAE during operation with semi-sitting position. MethodsBetween April 2018 and January 2019, 25 patients with vestibular schwannoma and 1 patient with posterior fossa meningioma received operation under semi-sitting position. Catheterization at jugular bulb was conducted by puncture of jugular vein with central venous catheter under guidance of ultrasound. The central venous catheter was then connected to a pressure sensor to continuously monitor the jugular bulb pressure (JBP). Both JBP and VAE were continuously monitored during operation to explore the relationship between JBP and intraoperative VAE under semi-sitting position. ResultsUnder supine position, JBP significantly increased when the head was rotated 45° to the right compared with that recorded at neutral head position. Among all 26 patients, VAE occurred in 4 (15.4%) cases during operation including 2 minor VAE and 2 moderate VAE. Among 3 patients with negative JBP relative to atmosphere pressure, 2 occurred VAE during operation; while only 2 patients occurred VAE among other 23 cases whose JBP was positive relative to atmosphere pressure (P = 0.009). ConclusionThe pressure of intracranial sinus could be continuously monitored by catheterization at jugular bulb. JBP monitoring could be used for prediction of intraoperative VAE. The rate of intraoperative VAE was significantly increased when JBP was negative relative to atmosphere pressure.