Perioperative Positioning in Neurosurgery: A Technical Note on Park Bench Positioning for the Obese Patient Using the “Arrowhead” Technique

Abstract

Complex neurosurgical procedures, such as those traversing the posterior fossa, require optimization of the operative corridor with advanced patient positioning methods. Even seemingly small changes in the location of intracranial mass lesions can require a more dramatic operative trajectory. Modifications of traditional lateral, semi-sitting, and park-bench approaches have been described in the literature to access these lesions; however, technical considerations with respect to enlarged body habitus have yet to be fully explored. Herein, we describe a technique for positioning obese patients in the park bench position, which is referred to as the “Arrowhead technique,” along with a literature review of positional complications and considerations in the setting of obesity.

Prevention of Postoperative Skin Disorders and Pressure Injuries in the Neurosurgical Park Bench Position Surgery: A Prospective Cohort Study

“…Previous reports have documented instances of pressure injury occurrence in the distinctive park bench position, a specialized lateral configuration employed in neurosurgical procedures [ 8 ]. Within this paradigm, where the cranium and a portion of the upper body extend beyond the confines of the operating table, the contact area is further diminished compared to the conventional lateral position, concomitantly heightening the proclivity for pressure injuries [ 9 ]. Moreover, in neurosurgical interventions, the inclination of the operating table towards the ventral side of the patient for optimal visualization of deep brain tissues augments the risk for pressure injuries, as rotational shear stress becomes more pronounced [ 10 ].…”