ABSTRACT
BACKGROUND: Acute venous air embolism (AE) is a well-known intraoperative complication of neurosurgical procedures, especially during surgical procedures performed in the sitting position, but it is a rare complication in the supine position. A case of a patient who developed an AE during a supratentorial craniotomy in the supine position is presented and the literature is reviewed. CASE DESCRIPTION: A 45-year-old man had a large left frontal convexity meningioma. He was operated upon and, during craniotomy in the supine position, suffered a massive episode of air embolism with severe respiratory and hemodynamic changes. The AE episode occurred while we were cutting the bone for the craniotomy before turning the bone flap. Because the patient was bleeding profusely, the bone flap was quickly removed to achieve hemostasis. Aspiration of irrigant into the cut bone surfaces through several venous diploic channels in the bone edges was observed. The procedure was terminated when hemostasis was achieved. The meningioma was successfully removed in a second operation. CONCLUSION: We think that our case should serve to warn the neurosurgical community about the risk of AE in supratentorial procedures in the supine or semisitting positions when preoperative radiological imaging studies show the presence of important venous channels in relation to the site of the tumor.