The Sitting Position in Neurosurgery: A Retrospective Analysis of 488 Cases

Standefer, Michael; Bay, Janet W.; Trusso, R.A.

doi:10.1227/00006123-198406000-00001

Cited by 213 publications

(98 citation statements)

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“…Although these operations do not require placement of the patient in the sitting position, air embolus can occur in both the prone and supine position, especially because the head may be elevated to decrease ICP and improve venous drainage. 45 Cortical incisions are made in the gyri and not the sulci, except in isolated cases when the latter is more appropriate. They should be sufficiently sized to allow removal of large tumors in a piecemeal fashion and to control bleeding at the edges of the tumor margin.…”

Section: Complication Avoidancementioning

confidence: 99%

Transcortical surgery for lateral ventricular tumors

Ellenbogen

2001

FOC

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Object Tumors of the lateral ventricle can be removed via two major approaches: the transcallosal or the transcortical route. The purpose of this study is to discuss the techniques and outcomes in transcortical surgery of tumors located in the lateral ventricle. Methods An experience with 29 consecutive lateral ventricular tumors resected via the transcortical route, over a 5-year period, is presented. The risks, complications, and outcomes of this surgical series, as well as those reported in the literature, are discussed. Surgical approaches to all five regions of the lateral ventricle are described. Neuropsychological, functional, and neurological outcomes are evaluated. Conclusions The transcortical technique makes it possible to resect lesions in each of the five regions of the lateral ventricle. It provides superior microsurgical working space and flexibility for maneuvering within the lateral ventricle. The key to a successful transcortical approach is an understanding of the functional anatomy of eloquent cortex to be broached, the location of the lesion, and its vascular supply. A clear understanding of the advantages and limitations of the transcortical approach makes performing this procedure for resection of large lesions in the ventricle both safe and effective. The majority of the patients in this series (86%) had a good outcome, returning to baseline functional status and suffering minimal morbidity. In the microsurgical era, transcortical surgery–related postoperative morbidity and outcome are dependent more on tumor histological type and site of origin than on approach.

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Section: Complication Avoidancementioning

confidence: 99%

Transcortical surgery for lateral ventricular tumors

Ellenbogen

2001

FOC

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“…The most feared complication of this position is venous air embolism. Air embolism may occur in any operation with an open vein and a gradient of venous pressure between the surgical site and the heart [8][9][10][11][12] . The incidence in the horizontal position is, however, lower.…”

Section: Discussionmentioning

confidence: 99%

“…This position permits drainage of blood and cerebrospinal fluid (CSF) allowing a better visualization and dissection of the cranial nerves, easier hemostasia and reduces venous bleeding. The main disadvantages of this position are the increased risk of venous air embolism and hemodynamic instability, especially in elderly patients [8][9][10][11][12] . The aim of this study was to evaluate the results of surgical treatment of VS in patients operated on through the retrosigmoid-transmeatal approach, in the dorsal decubitus position (mastoid position).…”

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confidence: 99%

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

Cardoso

Fernandes

Ramina

et al. 2007

Arq. Neuro-Psiquiatr.

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-Objective: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). Method: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7 th and 8 th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. Results: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. Conclusion: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.KEY WORDS: acoustic neuroma, vestibular schwannoma, mastoid position, venous air embolism.Neurinoma do acústico (schwannoma do vestibular): resultados do tratamento cirúrgico de 240 pacientes operados na posição de decúbito dorsal RESUMO -Objetivo: Avaliar o resultado do tratamento cirúrgico de pacientes portadores de schwannoma do vestibular (SV) operados em decúbito dorsal (posição de mastóide). Método: 240 pacientes foram submetidos a craniotomia retrosigmóide na posição de mastóide. A função do VII e VIII nervos cranianos foi monitorizada durante a cirurgia e a reconstrução da abertura do conduto auditivo interno foi realizada com retalho vascularizado de dura-mater, músculo e cola de fibrina. Resultados: A exérese foi completa em 99% dos casos, com mortalidade de 1,6%. Houve preservação da função do nervo facial em 85% dos casos e da audição em 40% dos pacientes com audição prévia e tumores menores de 1,5 cm. A incidência de fístula liquórica foi 5,8% e meningite 2,9%. Embolia gasosa foi registrada em 3% dos casos, não associada à mortalidade. Conclusão: O tratamento cirúrgico dos SV utilizando-se a posição de mastóide tem várias vantagens, com baixa morbidade e mortalidade. PALAVRAS-CHAVE: neurinoma do acústico, schwannoma vestibular, posição de mastóide, embolia gasosa.

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“…The use of the sitting or upright position for patients undergoing posterior fossa surgery facilitates surgical access but presents unique physiological challenges for the anesthetists with the potential for serious complications such as undesirable hemodynamic instability, venous air embolism, pneumocephalous, complications related to positioning like lingual/laryngeal oedema, brachial plexus injury, sciatic nerve injury, quadriparesis etc [1][2][3]. However the specific advantages which made this position popular include improved surgical exposure, provides good surgical assess, anatomical orientation, facilitates cerebral decompression, gravity aided blood and CSF drainage, decreased bleeding, less impairment of diaphragmatic movement leading improved ventilation with lower airway pressure, improved access to endotracheal tube, thorax, extremities, ability to observe face for signs of surgical stimulation of cranial nerves [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

Kore¹,

Waghalkar²,

Shetty³

et al. 2016

Int J of Biomed & Adv Res

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Aims and Objective: To assess the outcome following posterior fossa craniotomy in sitting position with respect to hemodynamic changes as well as intra and post operative complications. Material and Method: The present study was conducted in150 adult patients undergoing posterior fossa craniotomy in sitting position under general anaesthesia. Induction was done with thiopentone sodium 5mg/kg. Neuromuscular blockade was achieved with vecuronium bromide 0.1mg/kg to facilitate intubation. Radial arterial line was inserted preferably in left hand side for invasive blood pressure monitoring. Sitting position was given to patients' slowly over 20-30 minutes. Vital of the patients were monitored during and after giving sitting position. Patients were observed in ICU for first 48 hrs for neurological status, cardiovascular status, respiratory and surgical complications. Results: We found significant hemodynamic changes during and after giving sitting position to the patients which returned back to normal after 2 hrs of position. There were no perioperative cardiac events and neurological alteration. The incidence of venous air embolism was 5.3% and it was not associated with any postoperative morbidity and mortality. Other complications observed were pneumocephalous (0.7%), tongue oedema (2%) and glossopharyngeal nerve palsy (0.7%). Conclusions: Use of sitting position for posterior fossa surgery is safe anesthetic techniques and presents unique challenges for the anesthetist; taking measures to minimize hypotension and postoperative complications.

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The Sitting Position in Neurosurgery: A Retrospective Analysis of 488 Cases

Cited by 213 publications

References 0 publications

Transcortical surgery for lateral ventricular tumors

Transcortical surgery for lateral ventricular tumors

Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position

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