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Maragkos GA, Davanzo J, Roberts SM, et al. Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position. Cureus. 2019;11(4):e4355doi: 10.7759/cureus.4355.
Maragkos, G. A., Davanzo, J., Roberts, S. M., & Zacharia, B. E. (2019). Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position. Cureus, 11(4), e4355. https://doi.org/10.7759/cureus.4355
Maragkos, Georgios A, et al. "Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position." Cureus vol. 11,4 (2019): e4355. doi: https://doi.org/10.7759/cureus.4355
Maragkos GA, Davanzo J, Roberts SM, Zacharia BE. Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position. Cureus. 2019 Apr 01;11(4):e4355. doi: 10.7759/cureus.4355. PMID: 31192060; PMCID: PMC6550496.
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Cureus. 2019 Apr 01;11(4):e4355. doi: 10.7759/cureus.4355.

Paradoxical Air Embolism Without Patent Foramen Ovale During Craniotomy in the Sitting Position.

Cureus

Georgios A Maragkos, Justin Davanzo, S M Roberts, Brad E Zacharia

Affiliations

  1. Neurosurgery, Beth Israel Deaconess Medical Center, Boston, USA.
  2. Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, USA.
  3. Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, USA.
  4. Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.

PMID: 31192060 PMCID: PMC6550496 DOI: 10.7759/cureus.4355

Abstract

Craniotomy in the sitting position entails risk for venous air embolism (VAE). A 50-year-old male underwent pineal region mass resection through a sitting position craniotomy. Intraoperative transesophageal echocardiography confirmed the absence of intracardiac shunt. During craniotomy, VAE was noted inside the patient's right heart, leading to hemodynamic instability. After repositioning to the supine position, significant crossover of air into the left heart was noted. Postoperatively, multiple small embolic strokes were noted. Patients who undergo craniotomy in the sitting position and are not found to have a patent foramen ovale (PFO) are not free of risk for paradoxical air embolism (PAE).

Keywords: paradoxical air embolism; patent foramen ovale; venous air embolism

Conflict of interest statement

The authors have declared that no competing interests exist.

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