Comparison of outcomes following complex posterior fossa surgery performed in the sitting versus lateral position.
The sitting position during surgery is thought to provide important advantages, yet it remains controversial. We compared surgical and neurological outcomes for patients operated on in the sitting versus lateral position. Technically difficult procedures performed from the years 2001-2008 for complex lesions in the posterior fossa (vestibular schwannomas, other cerebellopontine angle tumors, foramen magnum meningiomas, brainstem cavernomas, pineal region tumors) were included. Outcomes in the two surgical positions were compared for all 243 patients (93 sitting, 38.3%; 150 lateral, 61.7%) and for 130/243 patients with vestibular schwannomas (50 sitting, 38.5%; 80 lateral, 61.5%). Sitting and lateral patient subgroups were clinically comparable. There were no surgical mortalities. The extent of removal and surgical and neurological outcomes were comparable. We found no advantage in surgical or neurological outcomes for use of the sitting or lateral surgical positions in technically difficult posterior fossa procedures. In vestibular schwannoma surgeries facial nerve preservation (House-Brackmann score 1-2) was related to extent of resection but not to surgical position. The choice of operative position should be based on lesion characteristics and the patient's preoperative medical status as well as the experience and preferences of the surgeons performing the procedure.
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. Electronic address: sergeyspektor@gmail.com.
Sergey
S
Spektor
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
Shifra
S
Fraifeld
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
Emil
E
Margolin
Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Department of Critical Care Medicine, S.L. Raheja Hospital, Mumbai, Maharashtra, India.
Sanjith
S
Saseedharan
Department of Anesthesiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Daniel
D
Eimerl
Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel.
Felix
F
Umansky
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D002648:Child; D003388:Cranial Fossa, Posterior / Q000000981:diagnostic imaging / Q000601:surgery*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D056888:Patient Positioning / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Cerebellopontine angle; Complications; Lateral position; Posterior fossa; Sitting position; Venous air embolism; Vestibular schwannoma