Comparison of outcomes following complex posterior fossa surgery performed in the sitting versus lateral position

Spektor, Sergey; Fraifeld, Shifra; Margolin, Emil; Saseedharan, Sanjith; Eimerl, D.; Umansky, Félix

doi:10.1016/j.jocn.2014.12.005

Cited by 31 publications

(27 citation statements)

References 42 publications

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“…The median time required for surgical positioning was less for patients in the HP group compared to the SP group (5.5 min IQR [3,7] vs. 10 min IQR [7,15] , p = 0.0281). The postoperative dysfunction of the cranial nerves was not significantly different between the groups (24 [45%] vs. 16 [29%], p = 0.0704).…”

Section: Surgical Proceduresmentioning

confidence: 92%

“…Both positions are relatively safe and useful but require team approach, experience and precautionary measures to minimize the risk of associated complications. In a group of 243 patients undergoing complex posterior fossa procedures, Spektor et al found no significant associations between patients' position and surgical or neurological outcomes (7). HP (prone, lateral, or park bench) is the preferred position in the majority of institutions due to simplicity and reduced risk of venous air embolism (VAE).…”

Section: Introductionmentioning

confidence: 99%

“…HP has also been linked to development of airway obstruction, cervical cord compression, inferior vena cava compression, orbital compression, and retinal ischemia, postoperative macroglossia, necrosis at pressure points after prolonged surgery and other complications (10,15,16). There are numerous reports describing increased blood loss in HP when compared to SP (2,7,10,17).…”

Section: Introductionmentioning

confidence: 99%

“…The advantages of SP include better anatomical orientation and surgical exposure, reduction in blood loss, better drainage of blood and cerebrospinal fluid from the operative field, easier access to the patient's face and chest by the anesthesiologist, and ease of cranial nerve monitoring (7,9,16).…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Patient Positioning on the Outcome During Posterior Cranial Fossa and Pineal Region Surgery

et al. 2020

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Background: Surgery on posterior cranial fossa (PCF) and pineal region (PR) carries the risks of intraoperative trauma to the brainstem structures, blood loss, venous air embolism (VAE), cardiovascular instability, and other complications. Success in surgery, among other factors, depends on selecting the optimal patient position. Our objective was to find associations between patient positioning, incidence of intraoperative complications, neurological recovery, and the extent of surgery.Methods: This observational study was conducted in two medical centers: The Ohio State University Wexner Medical Center (USA) and The Burdenko Neurosurgical Institute (Russian Federation). Patients were distributed in two groups based on the surgical position: sitting position (SP) or horizontal position (HP). The inclusion criteria were adult patients with space-occupying or vascular lesions requiring an open PCF or PR surgery. Perioperative variables were recorded and summarized using descriptive statistics. The post-treatment survival, functional outcome, and patient satisfaction were assessed at 3 months.Results: A total of 109 patients were included in the study: 53 in SP and 56 in HP. A higher proportion of patients in the HP patients had >300 mL intraoperative blood loss compared to the SP group (32 vs. 13%; p = 0.0250). Intraoperative VAE was diagnosed in 40% of SP patients vs. 0% in the HP group (p < 0.0001). However, trans-esophageal echocardiographic (TEE) monitoring was more common in the SP group. Intraoperative hypotension was documented in 28% of SP patients compared to 9% in HP group (p = 0.0126). A higher proportion of SP patients experienced a new neurological symptom compared to the HP group (49 vs. 29%; p = 0.0281). The extent of tumor resection, postoperative 3-months survival, functional outcome, and patient satisfaction were not different in the groups.Mavarez-Martinez et al. Patient Positioning for CraniotomiesConclusions: The SP was associated with, less intraoperative bleeding, increased intraoperative hypotension, VAE, and postoperative neurological deficit. More HP patients experienced macroglossia and increased blood loss. At 3 months, there was no difference of parameters between the two groups.Clinical Trial Registration: ClinicalTrials.gov: registration number NCT03364283.

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Section: Surgical Proceduresmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Effects of Patient Positioning on the Outcome During Posterior Cranial Fossa and Pineal Region Surgery

et al. 2020

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“…Spektor ve ark. 24 Oturur pozisyonda cerrahi geçiren hastaların anestezi uygulamasında N2O kullanımı hala tartışmalı bir konudur 29,30 . N2O'nun VHE oluşması durumunda hızla büyümesini sağlayarak erken tanı ve tedaviyi kolaylaştırabileceği savunulurken, diğer taraftan aynı nedenle ciddi hemodinamik bozulmaya neden olabileceği ve bu vakalarda kullanılmaması gerektiği tartışılmaktadır.…”

Section: Introductionunclassified

Anesthesia management in posterior fossa surgery

Karacaer

2019

Cukurova Medical Journal

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Anesthesia management in posterior fossa surgery may be challenging due to anatomical features, patient profile and operation position. Intraoperative hemodynamic changes, brain stem damage, and venous air embolism may occur. The aim of this study was to present our anesthesia experience in patients who underwent posterior fossa tumor surgery and to discuss the current literature. Materials and Methods: Thirty patients between the ages of 1-74 years, who underwent posterior fossa tumor surgery between 2015-2017 years were evaluated retrospectively. Results: The age of the patients was between 1 and 74 years and 76.7% of them were male. The mean operation time was 242,7 minutes. Complications observed during intraoperative period were hypotension (20%), brdycardia (13.3%), asystole (3.3%), venous air embolism (6.6%). 25 (83.3%) patients were extubated and 5 (%16,7) patients could not be extubated at the end of the operation. The mean duration of stay in the intensive care unit was 5.6 ± 4.6 days and the duration of hospital stay was 14.7 ± 15.7 days. In the postoperative period, 5 (16.7%) patients were re-operated, 1 (3.3%) patient was exitus, and 29 (96.7%) patients were discharged from the hospital. Conclusion: In posterior fossa surgery, anesthesia management may be a dynamic and challenging process. The complication rate can be minimized with appropriate patient selection and preoperative preparation, intraoperative monitoring and selection of anesthetic agents. Amaç: Posterior fossa cerrahisinde anestezi yönetimi, anatomik özellikler, hasta profilinin değişkenliği ve operasyon pozisyonu nedeniyle özelliklidir. İntraoperatif hemodinamik değişiklikler, beyin sapı hasarı ve venöz hava embolisi gibi komplikasyonlar oluşabilmektedir. Bu çalışmada, hastanemizde posterior fossada tümör nedeniyle opere olan hastalardaki anestezi deneyimlerimizin paylaşılması ve sonuçlarımızın literatür eşliğinde tartışılması amaçlanmıştır. Gereç ve Yöntem: Hastanemizde 2015-2017 yılları arasında posterior fossada tümör cerrahisi uygulanan 1 ile 77 yaş arasındaki 30 hastanın kayıtları retrospektif olarak değerlendirildi. Bulgular: Hasta yaşlarının 1 ile 74 yıl arasında olup, hastaların %76,7'sinin erkek olduğu saptandı. Ortalama operasyon süresi 242,7 dakika idi. İntraoperatif dönemde 6 (%20) hastada hipotansiyon, 4 (%13,3) hastada bradikardi, 1 (%3,3) hastada asistoli, 2 (%6,6) hastada venöz hava embolisi geliştiği tespit edildi. 25 (%83,3) hastanın operasyon sonunda ekstübe edildiği, 5 (%16,7) hastanın ise entübe şekilde yoğun bakım ünitesine çıkarıldığı saptandı. Yoğun bakım ünitesinde ortalama kalış süresi 5,6±4,6 gün, hastanede kalış süresi 14,7±15,7 gün idi. Postoperatif dönemde 5 (%16,7) hastanın yeniden opere edildiği, 1 (%3,3) hastanın exitus olduğu, 29 (%96,7) hastanın ise hastaneden taburcu edildiği saptandı. Sonuç: Posterior fossa cerrahisinde anestezi yönetimi, dinamik ve zorlu bir süreç olabilmektedir. Uygun hasta seçimi ve preoperatif hazırlık, intraoperatif monitörizasyon ve anestezik ajanların seçimi ile komplikasyon ...

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