{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:32Z","timestamp":1776096392586,"version":"3.50.1"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T00:00:00Z","timestamp":1772409600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intraoperative seizures pose a serious threat to patients undergoing neurosurgical procedures, potentially disrupting cases and increasing postoperative complications. While established risk factors, such as history of seizures and tumor location, are well documented, emerging evidence indicates hypocapnia, induced by controlled hyperventilation, may further reduce seizure threshold. Nevertheless, clinical data directly linking hyperventilation to intraoperative seizure incidence remain sparse in the current literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      The authors present the cases of 3 patients with skull base tumors who experienced intraoperative seizures during elective craniotomy. In all cases, end-tidal CO\n                      <jats:sub>2<\/jats:sub>\n                      (EtCO\n                      <jats:sub>2<\/jats:sub>\n                      ) levels fell below 27 mm Hg for extended periods. Seizure activity only resolved following EtCO\n                      <jats:sub>2<\/jats:sub>\n                      normalization and anticonvulsant administration. Notably, the patients had surgeries where physiological levels of EtCO\n                      <jats:sub>2<\/jats:sub>\n                      were maintained, resulting in successful surgeries with no seizure activity. All tumors were located at the skull base and involved main CNS arteries, raising the possibility that altered cerebral perfusion may have contributed to increased seizure susceptibility under hypocapnic conditions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>These cases highlight hypocapnia as a potentially modifiable risk factor for intraoperative seizures and underscore the need for judicious management. Given the risk of seizure induction under reduced cerebral blood flow, strict hyperventilation guidelines should be followed when tumors are in critical vascular territories.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25585\">https:\/\/thejns.org\/doi\/10.3171\/CASE25585<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25585","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:26:08Z","timestamp":1776093968000},"source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative seizure in the setting of tumor resection: illustrative cases"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7633-6008","authenticated-orcid":true,"given":"Thomas","family":"McCaffery","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Buclez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7628-8851","authenticated-orcid":true,"given":"Hithardhi","family":"Duggireddy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Razan R.","family":"Faraj","sequence":"additional","affiliation":[{"name":"Department of Surgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-0063","authenticated-orcid":true,"given":"Karen Salmeron-","family":"Moreno","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Pradilla","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomas","family":"Garzon-Muvdi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Emory University, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"J Neurosurg Anesthesiol","first-page":"234","article-title":"Incidence and risk factors for intraoperative seizures during elective craniotomy","volume":"31","author":"Kutteruf","year":"2019","unstructured":"Kutteruf RYang JTHecker JGKinney GAFurman MASharma D.Incidence and risk factors for intraoperative seizures during elective craniotomy. 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J Neurosurg. 2017;126(4):1296-1302. doi:10.3171\/2016.4.JNS151264"},{"issue":"2","key":"bib3","series-title":"J Neurosurg Anesthesiol","first-page":"194","article-title":"Risk factors and characteristics of intraoperative seizures during awake craniotomy: a retrospective cohort study of 562 consecutive patients with a space-occupying brain lesion","volume":"35","author":"Paquin-Lanthier","year":"2023","unstructured":"Paquin-Lanthier GSubramaniam SLeong KWRisk factors and characteristics of intraoperative seizures during awake craniotomy: a retrospective cohort study of 562 consecutive patients with a space-occupying brain lesion. 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J Stroke. 2016;18(1):114-116. doi:10.5853\/jos.2014.01228"},{"issue":"2","key":"bib15","series-title":"Surg Neurol","first-page":"167","article-title":"Invasion of the internal carotid artery by cavernous sinus meningiomas","volume":"52","author":"Shaffrey","year":"1999","unstructured":"Shaffrey MEDolenc VVLanzino GWolcott WPShaffrey CI.Invasion of the internal carotid artery by cavernous sinus meningiomas. Surg Neurol. 1999;52(2):167-171. doi:10.1016\/s0090-3019(99)00092-0"},{"issue":"1","key":"bib16","series-title":"Neurosurgery","first-page":"6","article-title":"Guidelines for the management of severe traumatic brain injury, fourth edition","volume":"80","author":"Carney","year":"2017","unstructured":"Carney NTotten AMO\u2019Reilly CGuidelines for the management of severe traumatic brain injury, fourth edition. 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Br J Anaesth. 2016;116(6):759-769. doi:10.1093\/bja\/aew096"},{"key":"bib8","series-title":"Front Neurol","article-title":"Hyperventilation therapy for control of posttraumatic intracranial hypertension","volume":"8","author":"Godoy","year":"2017","unstructured":"Godoy DASeifi AGarza DLubillo-Montenegro SMurillo-Cabezas F.Hyperventilation therapy for control of posttraumatic intracranial hypertension. Front Neurol. 2017;8:250. doi:10.3389\/fneur.2017.00250"},{"issue":"5","key":"bib9","series-title":"Curr Opin Anaesthesiol","first-page":"568","article-title":"Hyperventilation in neurological patients: from physiology to outcome evidence","volume":"32","author":"Zhang","year":"2019","unstructured":"Zhang ZGuo QWang E.Hyperventilation in neurological patients: from physiology to outcome evidence. Curr Opin Anaesthesiol. 2019;32(5):568-573. doi:10.1097\/ACO.0000000000000764"},{"issue":"3","key":"bib10","series-title":"Asian J Neurosurg","first-page":"475","article-title":"A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients","volume":"12","author":"Gaur","year":"2017","unstructured":"Gaur PHarde MGujjar PDeosarkar DBhadade R.A study of partial pressure of arterial carbon dioxide and end-tidal carbon dioxide correlation in intraoperative and postoperative period in neurosurgical patients. 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