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DOI: 10.1055/s-0044-1779439
Paradoxical Air Embolism in Spinal Surgery: Case Report and Literature Review
Embolia gasosa paradoxal em cirurgia de coluna: Relato de caso e revisão de literatura Funding Statement No funding was received in any phase of the article's production.
Abstract
Air embolism (AE) is a subtype of embolism, caused by the entry of air into the vascular system. It is a predominantly iatrogenic complication, and its symptomatic form is severe, although uncommon. In some cases, a venous thrombi may pass into the arterial system through a venous-arterial shunt, characterizing a paradoxical embolism. Here, we describe the case of a previously healthy 44-year-old female who underwent cauda equina decompression and lumbar epidural abscess drainage. The patient suffered a paradoxical AE intraoperatively and died after 4 days. The occurrence of AE in lumbar spine surgeries in the prone position is rare, but the surgical team must be attentive to its clinical signs and quickly institute initial management when necessary.
Resumo
A embolia gasosa (EG) é um subtipo de embolia, causada pela entrada de ar no sistema vascular. É uma complicação predominantemente iatrogênica e sua forma sintomática é grave, embora incomum. Em alguns casos, um trombo venoso pode migrar para o sistema arterial através de um shunt venoso-arterial, caracterizando uma embolia paradoxal. Aqui, descrevemos o caso de uma mulher de 44 anos, previamente saudável, submetida a descompressão da cauda equina e drenagem de abscesso peridural lombar. A paciente sofreu uma EG paradoxal no intraoperatório e morreu 4 dias depois. A ocorrência de EG em cirurgias da coluna lombar em posição prona é rara, mas a equipe cirúrgica deve estar atenta aos seus sinais clínicos e, quando necessário, instituir o manejo inicial rapidamente.
Ethics Approval and Consent to Participate
Ethical approval was waived by the local Ethics Committee of the Faculdade Meridional - IMED in view of the retrospective nature of the study and all the procedures being performed were part of the routine care. The study was conducted in accordance with the declaration of Helsinki.
Consent for Publication
Informed consent forms were acquired from the patient's family, as the patient died before the article was written.
Availability of Data and Material
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Author Contributions
Each author made significant individual contributions to this manuscript. Miotto GJ: Main physician responsible for the patient's care and main surgeon; review of the manuscript's intellectual content; approval of the final version of the manuscript. Martio AE: Development and writing of the article; approval of the final version of the manuscript. Mesquita Filho PM: Development and writing of the article; approval of the final version of the manuscript. Karam OR: Physician responsible for the patient's care, auxiliary surgeon; writing of the article; approval of the final version of the manuscript. Padua WL: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript. Berres TO: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript. Ferreira Saltiél RM: Critical review of the intellectual content of the manuscript; approval of the final version of the manuscript.
Publication History
Received: 03 February 2023
Accepted: 04 August 2023
Article published online:
02 May 2024
© 2024. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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