An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery

Venous air embolism (VAE) is the entrainment of air either from a surgical site or from the environment into the venous or arterial vasculature, which can subsequently cause systemic effects. Many cases are subclinical but large volume and high rate of accumulation of air entrainment are potentially life-threatening. The relative risk is high in sitting position craniotomy and posterior fossa surgery but low in burr hole neurosurgery such as in deep brain stimulation (DBS) surgery. The authors report their experience of managing an unusual case of repeated VAE during both sides of burr-hole and electrode insertion in awake bilateral DBS surgery.Keywords: awake craniotomy, burr hole, deep brain stimulation, neurosurgery, venous air embolis