Abstract
Pulmonary embolism is a recognized major perioperative complication. Guidelines have been published by the committee for prevention of venous thromboembolism in Japan. However, there are few reports about perioperative deep venous thrombosis/pulmonary embolism in neurosurgery and the frequency of occurrence and strategies for prevention have not been presented by Japanese neurosurgical society. In this article we present a case of massive pulmonary embolism 1 month after neck clipping for a ruptured aneurysm of the anterior communicating artery. The case was a 63-year-old female patient who underwent the above neurosurgical procedure. One month after surgical intervention she experienced sudden cardiopulmonary arrest. A presumptive diagnosis of pulmonary embolism was made and the patient underwent mechanical guide-wire destruction of embolized thrombi under percutaneous cardiopulmonary support (PCPS), which resulted in successful resuscitation. Her functional outcome on hospital discharge was modified Rankin Scale Grade 4. In the United States, various projects are ongoing to prevent surgical complications including pulmonary embolism with prophylactic use of post-operative low-dose unfractionated heparin recommended even in neurosurgical patients. It is necessary to accumulate data regarding deep venous thrombosis/pulmonary embolism in neurosurgical cases in order to be able to develop effective peri-operative screening methods and preventive measures.
