Experiences with the Sitting Position in Posterior Fossa Surgery in 310 Patients
|Heymanns V1#, Jung S2#, Tallo A2, Cheko A2, Alyeldien A2, Tsogkas A2, Doukas A3, Daemi-Attaran P2, Alsharif M2, Mahvash M4, Scholz M2 and Petridis AK2,5*|
|1Department of Pediatrics, Sana Kliniken Duisburg, Germany|
|2Department of Neurosurgery, Sana Kliniken Duisburg, Germany|
|3Department of Neurosurgery, University Schleswig Holstein, Campus Kiel, Germany|
|4Department of Neurosurgery, Helios Klinikum Siegburg, Germany|
|5 Department of Neurosurgery, University Hospital Duesseldorf, Moorenstr, 540225 Duesseldorf, Germany|
|#Verena Heymanns and Suzin Jung contributed equally|
|Corresponding Author :||Athanasios K. Petridis
Department of Neurosurgery
University Hospital Duesseldorf
Moorenstr, 540225 Duesseldorf, Germany
E-mail: [email protected]
|Received August 28, 2015; Accepted October 17, 2015; Published October 20, 2015|
|Citation:Heymanns V, Jung S, Tallo A, Cheko A, Alyeldien A, et al. (2015) Experiences with the Sitting Position in Posterior Fossa Surgery in 310 Patients. J Neurol Disord S1:002. doi:10.4172/2329-6895.S1-002|
|Copyright: ©2015 Heymanns V, et al.. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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Introduction: The sitting position for lesions in the posterior fossa has been controversially discussed in the literature because of high risk of air embolism. We report our experience with the sitting position and evaluate the risk of air embolism.
Material and Methods: We performed a retrospective analysis of patient charts (N=310), surgical and anesthesiological reports to evaluate the occurrence of intraoperative complications. Pre and post-operative MRIs were also evaluated for occurrence of embolic infarctions. The patients were operated in our department from 2009–2013.
Results: Only 0.6% of patients suffered from embolic infarctions. Most of the complications were similar to the complications which occur in the lateral oblique position. Preoperatively, all patients were evaluated with echocardiography to exclude a patent foramen ovale (those patients were not operated in the sitting position).
Conclusion: The sitting position is excellent for surgery in the posterior fossa since blood is washed out and does not intervene with the surgical field. The risk of air embolism is very low when a patent foramen ovale has been excluded. Intraoperatively, a right ventricular catheter is inserted to aspirate air if needed. Meticulous coagulation, irrigation of the surgical domane and application of bone wax to the craniotomy edges reduces the risk of venous air embolism.