[The ventrolateral position].
OBJECTIVE
To propose an alternative to the sitting position and the other horizontal positions while maintaining the advantages of the sitting position and assuring maximum safety for the patient particularly with respect to the risk of air embolism. POSITION: The patient is positioned as for the sitting position with the median axis of the posterior cranial fossa prolonging the spinal axis. The head is maintained by a Mayfield head holder and is inclined without force. The patient rests laterally on the apron, the thorax and the lower limbs resting on cushions. The upper limbs rest on the arm rests interdependent with the table facilitating surgical access and rolling movements.


METHODS
Since 1993, this position was used for 556 patients. For 81.3% of the patients lesions were located in the posterior cranial fossa and for 12.75% in the supratentorial region. Access to the cervical area was achieved for 4.7% of the patients.


RESULTS
This position gave us access to the lesions without specific difficulties, irrespective of the patient's morphology. There were no air embolism events and no capnographic anomaly was reported.


CONCLUSIONS
Since discontinuing use of the sitting position in our institution, we have found that the ventrolateral position can replace the sitting position advantageously. It allowed us to approach lesions located in a large area, from the cervical spine to the supratentorial area located behind external auditory meatus, and was compatible with anesthetic and surgical requirements.
Guarnieri
J
J
Service de Neurochirurgie, CHU, avenue de la Côte-de-Nacre, 14033 Caen Cedex. guarnieri-j@chu-caen.fr
Derlon
J-M
JM
Houtteville
J-P
JP
D001932:Brain Neoplasms / Q000601:surgery; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology; D004618:Embolism, Air / Q000517:prevention & control; D019416:Head Movements; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D019635:Neurosurgical Procedures; D011187:Posture / Q000502:physiology*; D012149:Restraint, Physical; D012189:Retrospective Studies; D013131:Spine / Q000033:anatomy & histology