Intraoperative venous air embolism in the non-cardiac surgery-the role of perioperative echocardiography in a case series report

Pineal region tumours in the sitting position: how I do it

Background

Pineal region tumours remain challenging neurosurgical pathologies.

Methods

Detailed anatomical knowledge of the posterior incisural space and its variations is critical. An opaque arachnoidal membrane seals the internal cerebral and basal veins, leading to thalamic, basal ganglia, mesencephalic/pontine infarctions if injured. Medium-size tumours can be removed en-bloc with all traction/manipulation applied on the tumour side, virtually without contact of ependymal surfaces of the pulvinars or third ventricle. Sacrifice of the cerebello-mesencephalic fissure vein may be required.

Conclusions

The sitting position offers superior anatomical orientation and remains safe with experienced teams. Meticulous microsurgical techniques and detailed anatomical knowledge are likely to secure safe outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00701-021-04821-3.

Remaining Vigilant to Paradoxical Air Embolism in Patients Undergoing Hysteroscopic Surgery: A Case Report and Review of the Literature

The purpose of this case study and review was to understand the perianesthestic care of paradoxical air embolism (PAE) in patients undergoing hysteroscopic surgery. The perianesthestic management record of a patient undergoing hysteroscopic surgery was analyzed to study the characteristics of PAE, and the literature describing the perianesthestic care for PAE was reviewed. The first symptom of PAE in hysteroscopic surgery is often a decrease in end-tidal carbon dioxide (ETCO₂), and the complications include embolism of the pulmonary artery, coronary artery, and cerebral artery. The best monitoring method is continuous ETCO₂ monitoring, and intraoperative echocardiography is an excellent method to diagnose and guide the treatment of PAE. PAE is a rare but serious complication of hysteroscopic surgery that is associated with organ ischemia and hypoxia. Prevention and treatment of PAE requires the vigilance and cooperation of not only perianesthesia nurses and anesthesiologists but also the surgeons and operating room nurses. Early prevention, proper monitoring, and effective treatment are the keys to successful rescue for PAE.