Paraplegia After Sitting Position

Mérat, Stéphane; Jp, Lévecque; Gulluche, Y. Le; Diraison, Y.; Delmas, J-M.; Faillot, Thierry; Brinquin, L.

doi:10.1213/00000539-200202000-00049

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…1,7 Over the years, the popularity of this position for various neurosurgical and spinal approaches has dwindled because of untoward and potentially devastating complications. [3][4][5][6][7][8] Pneumocephalus is seen in virtually all cases following craniotomy in the sitting position. 2,3 However, it is the rare but dreaded sequelae of a tension pneumocephalus that can be particularly troubling for the patient and surgeon alike.…”

Section: Discussionmentioning

confidence: 99%

“…12,15 Patients should be reassured that the paralysis usually abates over time. 1,5,8 For persistent cases, botulinum toxin injections or more invasive corrective surgical procedures can be used. 12,15…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Among the numerous reported complications are pneumocephalus, macroglossia, air embolism, and (even more devastating) spinal cord infarction. [3][4][5][6][7][8] Pneumocephalus is seen in virtually all cases following surgery in the sitting position. 2,8 Patients frequently present with worsening headaches; however, neurologic manifestations are rare.…”

Section: Case Report History and Examinationmentioning

confidence: 99%

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Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Stevens

Colen²,

Ham

et al. 2007

J Child Neurol

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A rare case of delayed lateral rectus palsy in a patient following resection of a pineal lesion in the sitting position is presented. Postoperative pneumocephalus is common following craniospinal surgical intervention in the sitting position. The sixth cranial nerve is frequently injured because of its prolonged intracranial course. A 13-year-old girl was evaluated for unremitting headaches. No focal deficits were demonstrated on neurological examination. Magnetic resonance imaging revealed a cystlike pineal region mass with peripheral enhancement following intravenous contrast administration. A supracerebellar infratentorial craniotomy was performed in the sitting position, and complete resection of the lesion was achieved. Her postoperative course was complicated by sixth nerve palsy on the third postoperative day. Her symptoms improved with conservative management. The occurrence of sixth cranial nerve palsy secondary to pneumocephalus is a rare entity. Even rarer is the report of this anomaly following craniotomy in the sitting position. This patient's symptoms manifested in a delayed fashion. Although uncommon, this complication should be considered in patients undergoing cranial or spinal surgical interventions in this position.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Report History and Examinationmentioning

confidence: 99%

See 1 more Smart Citation

Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Stevens

Colen²,

Ham

et al. 2007

J Child Neurol

View full text Add to dashboard Cite

show abstract

“…Complication rates for sitting cervical procedures are lower (0.7%) than for sitting cranial procedures, with an odds ratio of 0.28 [76]. There are numerous potential complications associated with the sitting position, including venous air embolism (VAE), hypotension, paradoxical air embolism, airway edema, macroglossia, decreased cerebral pressure, pneumocephalus, subdural hematoma dislocation of the elbow, displacement of endotracheal tubes, jugular venous obstruction, compartment syndrome, lumbosacral pressure sores, central cord syndrome, paraplegia, quadriplegia, and common peroneal nerve palsy [77][78][79][80][81][82][83][84][85]. The most common and feared complications of this position are VAE and associated hypotension.…”

Section: Sitting Positionmentioning

confidence: 99%

Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

et al. 2023

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Spine surgery has advanced tremendously over the last decade. The number of spine surgeries performed each year has also been increasing constantly. Unfortunately, the reporting of position-related complications in spine surgery has also been steadily increasing. These complications not only result in significant morbidity for the patient but also raises the risk of litigation for the surgical and anesthetic teams. Fortunately, most position-related complications are avoidable with basic positioning knowledge. Hence, it is critical to be cautious and take all necessary precautions to avoid position-related complications. We discuss the various position-related complications associated with the prone position, which is the most commonly used position in spine surgery, in this narrative review. We also discuss the various methods for avoiding complications. Furthermore, we briefly discuss less commonly used positions in spine surgery, like the lateral and sitting positions.

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“…1 2 The four-channel frontal processed EEG is routinely used for monitoring the depth of anesthesia (DOA). There are several reports of bispectral index (BIS), a processed EEG monitor detecting cerebral ischemia during carotid surgery, 3 aortic aneurysm surgery, 4 and other general surgery. 5 But the use of BIS/SedLine sedation monitor as cerebral ischemia monitor during cerebral aneurysm surgery is scarcely reported.…”

Section: Introductionmentioning

confidence: 99%

Can the Processed EEG Be Utilized as a Cerebral Ischemia Monitor during the Temporary Clip Application in Anterior Circulation Aneurysm Surgery?

Mariappan

Babu

Nair

et al. 2022

J Neuroanaesth Crit Care

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Patients undergoing cerebral aneurysm clipping are at risk for cerebral ischemia. Ischemic tolerance varies among individuals. Hence, multimodal intraoperative neuromonitoring (IONM) is essential. IONM is not available in many centers. This case report highlights the utilization of processed electroencephalography (EEG) as a cerebral ischemia monitor during temporary clip application. Our patient underwent clipping of a ruptured anterior-communicating artery aneurysm. After the temporary clip applications on the right and left, A1 arterial segments led to a transient drop of somatosensory evoked potentials (SSEPs). At the same time, the frontal four-channel processed EEG showed a burst suppression (BS) pattern. Blood pressure augmentation and the removal of temporary clips helped restore the SSEP back to baseline and the disappearance of the BS pattern in processed EEG. During the steady state of anesthesia, the sudden appearance of the BS pattern in processed EEG can be attributed to clip-induced cerebral ischemia after ruling out other potential causes for BS.

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Paraplegia After Sitting Position

Cited by 7 publications

References 4 publications

Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Delayed Lateral Rectus Palsy Following Resection of a Pineal Cyst in Sitting Position: Direct or Indirect Compressive Phenomenon?

Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

Can the Processed EEG Be Utilized as a Cerebral Ischemia Monitor during the Temporary Clip Application in Anterior Circulation Aneurysm Surgery?

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