Carbon Dioxide Embolism During Transoral Endoscopic Thyroidectomy Vestibular Approach: A Case Report

Abstract

Carbon dioxide (CO₂) embolism is a rare but serious complication during transoral endoscopic thyroidectomy vestibular approach (TOETVA). We report the case of a 58-years-old Thai woman with hypertension and hyperthyroidism who underwent TOETVA for completion thyroidectomy. Intraoperatively, injury to the anterior jugular vein likely caused CO₂ embolism, indicated by a sudden rise in end-tidal CO₂. The procedure was converted to open surgery. Postoperatively, she developed seizures, left-sided weakness, and confusion. Imaging confirmed cerebral gas embolism, and echocardiography revealed a patent foramen ovale. She was treated with antiepileptic medications and hyperbaric oxygen therapy, resulting in full neurological recovery. This case shows that CO₂ embolism can still occur during TOETVA at low insufflation pressure, following anterior jugular vein injury. A sudden end-tidal CO₂ change may be an early clue, and early recognition with prompt hyperbaric oxygen therapy (HBOT) can help prevent lasting neurologic deficits.