BJA Advance Access published online on April 4, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep063
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Patent foramen ovale and neurosurgery in sitting position: a systematic review
1 Department of Neurosurgery and Intensive Care Medicine
2 Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland
* Corresponding author. E-mail: bernhard.meier{at}insel.ch
We have conducted a systematic review of air embolism complications of neurosurgery in the sitting position and patent foramen ovale (PFO) closure. It assesses the risk and benefit of PFO closure before neurosurgery in the sitting position. The databases Medline, Embase, and Cochrane Controlled Trial Register were systematically searched from inception to November 2007 for keywords in both topics separately. In total, 4806 patients were considered for neurosurgery in sitting position and 5416 patients underwent percutaneous PFO closure. The overall rate of venous air embolism during neurosurgery in sitting position was 39% for posterior fossa surgery and 12% for cervical surgery. The rate of clinical and transoesophageal echocardiography detected paradoxical air embolism was reported between 0% and 14%. The overall success rate for PFO closure using new and the most common closure devices was reported 99%, whereas the average risk of major complications is <1%. On the basis of our systematic review, we recommend screening for PFO and considering closure in cases in which the sitting position is the preferred neurosurgical approach. Our proposed management including the time of PFO closure according to available data is presented. However, the conclusions from our systematic review may be limited due to the lack of level A evidence and from using data from observational cohort studies. Thus, definite evidence-based recommendations require prospective evaluation of the issue in well-designed studies.
Keywords: anaesthesia, neurosurgical; complications, embolism, air; closure device, foramen ovale, patent/complications; heart, congenital defects, patent foramen ovale; position, sitting
These authors contributed equally to the manuscript.
Declaration of interest. B.M. is proctor for and recipient of research grants and speaker fees from AGA Medical, manufacturer of PFO closure devices.
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- Preoperative percutaneous patent foramen ovale closure prior to neurosurgery in the sitting position
- Stephen T Webb, et al.
- British Journal of Anaesthesia, 11 May 2009 [Full text]
- Response to the letter of Webb T. et al. for the article “Patent foramen ovale and neurosurgery in sitting position: a systemic review”
- Bernhard Meier, et al.
- British Journal of Anaesthesia, 19 May 2009 [Full text]