The semisitting position in pediatric neurosurgery: pearls and pitfalls of a 10-year experience

2021 ◽  
pp. 1-10
Author(s):  
Fritz Teping ◽  
Stefan Linsler ◽  
Michael Zemlin ◽  
Joachim Oertel
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Pediatric Population ◽  
Clinical Status ◽  
Skull Fracture ◽  
Pediatric Neurosurgery ◽  
Time Frame ◽  
Special Focus ◽  
Posterior Fossa Surgery ◽  
Venous Air Embolism

OBJECTIVE The authors sought to investigate the pearls and pitfalls of using the semisitting position in pediatric neurosurgery, with special focus on related morbidity and surgical practicability. METHODS All pediatric cases at a single institution were evaluated retrospectively. Those patients who underwent procedures in the semisitting position between December 2010 and December 2020 were included in the final analysis. Results were compared with all children who underwent surgery in the prone position for posterior fossa lesions within the same time frame. RESULTS A total of 42 posterior fossa surgeries were performed in 38 children in the semisitting position between December 2010 and December 2020. The mean patient age at the time of surgery was 8.9 years (range 13 months–18 years). The data of 24 surgeries performed in the prone position in 22 children during the same time frame were analyzed in comparison. Three children (7.9%) were diagnosed with a persistent foramen ovale preoperatively. The surgery was completed in all cases. The incidence of venous air embolism (VAE) was 11.9%. There was no VAE-related hemodynamic instability, infarction, or death. Endoscopic techniques were applied safely in 14 cases (33.3%). Postoperative pneumocephalus occurred significantly more frequently in patients who had undergone procedures in the semisitting position (p < 0.05), but without the need for intervention. During 1 surgery (2.4%), the patient experienced a postoperative skull fracture and epidural bleeding due to the skull clamp application. Clinical status of the patients immediately after surgery was improved or stable in 33 of the 42 surgeries (78.6%) performed in the semisitting position. CONCLUSIONS With attentive performance and an experienced surgical team, the semisitting position is a safe option for posterior fossa surgery in the pediatric population. With a comparable complication profile, the semisitting position offers excellent anatomical exposure, which is ideal for the application of endoscopic visualization. Careful skull clamp application and appropriate monitoring are highly recommended.

P06.05 The Sitting Position in the Very Young Pediatric Population: Pearls and Pitfalls of a 10-Years’ Experience

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii25-ii25
Author(s):  
S Linsler ◽  
F Teping ◽  
J Oertel
Keyword(s):  
Posterior Fossa ◽  
Pediatric Population ◽  
Clinical Status ◽  
Skull Fracture ◽  
Special Focus ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Endoscopic Techniques ◽  
Age At Surgery ◽  
Persistent Foramen Ovale

Abstract BACKGROUND To investigate pearls and pitfalls of the sitting positioning in the pediatric population with special focus on related morbidity and surgical practicability. MATERIAL AND METHODS A retrospective analysis of a prospectively maintained internal database was performed. All pediatric patients younger than 18 years at date of surgery, who underwent procedures in sitting position between 01/2010 and 10/2020 were included into this analysis. RESULTS A total of 42 of posterior fossa surgeries were performed in 38 children between 01/2010 and 10/2020. Mean age at surgery was 8.9 years (13 months - 18 years). Mean height and weight were 134.4 (± 30.2) cm and 36.6 (± 21.7) kg respectively. Three children (7.9%) were diagnosed with persistent foramen ovale. Electrophysiologic monitoring was unremarkable during positioning in all cases. Mean time needed for anesthesiologic preparation and positioning was 84.5 (± 20.6) minutes. Perioperative blood transfusion was needed in 5 cases (11.9%). Incidence of VAE was 11.9%. There was no VAE related severe complication. One child (2.4%) showed postoperative skull fracture and epidural bleeding due to skull clamp application. Clinical status immediately after surgery was favorable or stable in 33 of the cases (78.6%). CONCLUSION Attentive performance and an experienced surgical team provided; the sitting position remains a safe variant for posterior fossa surgery in the pediatric population. Precautious skull clamp application and appropriate monitoring is highly recommended. Considering eloquent aspects, the sitting position offers excellent anatomical exposure and is ideal for combination with endoscopic techniques.

Neuroendoscopic Aspiration of Blood Clots in the Cerebral Aqueduct and Third Ventricle During Posterior Fossa Surgery in the Prone Position

2018 ◽  
Vol 17 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Alberto Feletti ◽  
Riccardo Stanzani ◽  
Matteo Alicandri-Ciufelli ◽  
Giuliano Giliberto ◽  
Matteo Martinoni ◽  
...  
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Blood Clot ◽  
Third Ventricle ◽  
Cerebral Aqueduct ◽  
Posterior Fossa Surgery ◽  
The Third ◽  
Blood Clots ◽  
Surgical Field

AbstractBACKGROUNDDuring surgery in the posterior fossa in the prone position, blood can sometimes fill the surgical field, due both to the less efficient venous drainage compared to the sitting position and the horizontally positioned surgical field itself. In some cases, blood clots can wedge into the cerebral aqueduct and the third ventricle, and potentially cause acute hydrocephalus during the postoperative course.OBJECTIVETo illustrate a technique that can be used in these cases: the use of a flexible scope introduced through the opened roof of the fourth ventricle with a freehand technique allows the navigation of the fourth ventricle, the cerebral aqueduct, and the third ventricle in order to explore the cerebrospinal fluid pathways and eventually aspirate blood clots and surgical debris.METHODSWe report on one patient affected by an ependymoma of the fourth ventricle, for whom we used a flexible neuroendoscope to explore and clear blood clots from the cerebral aqueduct and the third ventricle after the resection of the tumor in the prone position. Blood is aspirated with a syringe using the working channel of the scope as a sucker.RESULTSA large blood clot that was lying on the roof of the third ventricle was aspirated, setting the ventricle completely free. Other clots were aspirated from the right foramen of Monro and from the optic recess.CONCLUSIONWe describe this novel technique, which represents a safe and efficient way to clear the surgical field at the end of posterior fossa surgery in the prone position. The unusual endoscopic visual perspective and instrument maneuvers are easily handled with proper neuroendoscopic training.

Occipital condyle to cervical spine fixation in the pediatric population

2014 ◽  
Vol 13 (1) ◽  
pp. 45-53 ◽  
Author(s):  
Libby Kosnik-Infinger ◽  
Steven S. Glazier ◽  
Bruce M. Frankel
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Pediatric Population ◽  
Occipital Bone ◽  
Occipital Condyle ◽  
Type I ◽  
Posterior Fossa Surgery ◽  
Clinical Scenarios ◽  
Spine Fixation ◽  
Cervical Spine Fixation

Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.

Sitting Prone Position for the Posterior Surgical Approach to the Spine and Posterior Fossa

Neurosurgery ◽  
1982 ◽  
Vol 10 (2) ◽  
pp. 232-235 ◽  
Author(s):  
Albert W. Cook ◽  
Tariq S. Siddiqi ◽  
Florence Nidzgorski ◽  
Hadley A. Clarke
Keyword(s):  
Central Venous Pressure ◽  
Prone Position ◽  
Posterior Fossa ◽  
Surgical Approach ◽  
Airway Pressure ◽  
Venous Pressure ◽  
Posterior Fossa Surgery ◽  
Comparative Efficacy ◽  
Central Venous ◽  
Significant Difference

Abstract The sitting prone position is compared with the standard laminectomy prone position and the sitting up position for posterior fossa surgery. We measured central venous pressure and airway pressure with the patient in different positions to determine the comparative efficacy of the sitting prone position. On a linear average, the central venous pressure increased by 6.83 cm H2O and the airway pressure increased by 3.16 cm H2O when the patient was changed from the supine to the standard prone position under general anesthesia; with a change from the standard prone position to the sitting prone position, the central venous pressure decreased by 10.45 cm H2O and the airway pressure decreased by 3.66 cm H2O. However, comparing the sitting prone position for posterior fossa surgery with the sitting up position, there was no statistically significant difference in central venous or airway pressure.

scholarly journals POGOSTOST ZRAČNE EMBOLIJE IN POOPERATIVNI ZAPLETI PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU Skrajšana verzija naslova: ZRAČNA EMBOLIJA PRI NEVROKIRURŠKIH POSEGIH V SEDEČEM POLOŽAJU

2015 ◽  
Vol 84 (9) ◽  
Author(s):  
Alenka Spindler Vesel ◽  
Nina Pirc ◽  
Božidar Visočnik ◽  
Jasmina Markovič - Božič
Keyword(s):  
Cervical Spine ◽  
Posterior Fossa ◽  
Spine Surgery ◽  
Air Embolism ◽  
Neck Surgery ◽  
Postoperative Treatment ◽  
Posterior Fossa Surgery ◽  
Cervical Spine Surgery ◽  
Venous Air Embolism ◽  
Doppler Probe

Background: Posterior fossa surgery and cervical spine surgery are at risk for venous air embolism (VAE) occurrence. Mostly air emboli are small and asymptomatic, but invasion of large quantity of air in the circulation is symptomatic and potentially lethal. Transesophageal echocardiography is the most sensitive method for detection of air emboli in the heart, followed by the precordial Doppler probe, end tidal carbon dioxide monitoring (etCO2) and others.Methods: In our 14- years retrospective review we evaluated the incidence of VAE and postoperative complications in patients with posterior fossa surgery or cervical spine surgery. VAE was recognized by using Doppler probe and/or drop of etCO2. If VAE occurred, aspiration of air through the CVC was used to prevent or to minimized VAE occurrence, the surgeon was warned about the incident. VAE treatment was supportive.Results: VAE was recognized in 74 patients. Two patients after head surgery and four patients after neck surgery needed postoperative treatment in intensive care unit and controled mechanical ventilation. In six patients after head surgery and in four patients after neck surgery new neurological symptoms occurred. Two patients after head surgery died due to complications of massive VAE.Conclusions: VAE is rare, but serious complication of neurosurgery in sitting position. Preventive treatment, early detection of VAE, supportive treatment and treatment of cardiovascular complications are necessary for survival of patients with VAE.

Massive Macroglossia After Posterior Fossa Surgery in the Prone Position

1998 ◽  
Vol 10 (1) ◽  
pp. 34-36 ◽  
Author(s):  
Evan G. Pivalizza ◽  
Jeffrey Katz ◽  
Sandip Singh ◽  
Wei Liu ◽  
Becky L. McGraw-Wall
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery

Paraplegia after posterior fossa surgery in prone position: can we prevent it?

2016 ◽  
Vol 33 (1) ◽  
pp. 25-26 ◽  
Author(s):  
Rodolfo Maduri ◽  
R-T. Daniel ◽  
M. Diezi ◽  
J. Cotting ◽  
M. Messerer
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery

The sitting or prone position for posterior fossa surgery?

2002 ◽  
Vol 12 (5) ◽  
pp. 466-467
Author(s):  
DANIEL VISCHOFF ◽  
PIERRE LIMOGES ◽  
CLAUDE MERCIER
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Posterior Fossa Surgery

Quadriplegia in a patient who underwent posterior fossa surgery in the prone position

2002 ◽  
Vol 96 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Cheng-Shyuan Rau ◽  
Cheng-Loong Liang ◽  
Chun-Chung Lui ◽  
Tao-Chen Lee ◽  
Kang Lu
Keyword(s):  
Prone Position ◽  
Posterior Fossa ◽  
Cervical Spinal Cord ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Resonance Imaging ◽  
Content Type ◽  
Cervical Disease ◽  
Cerebellar Medulloblastoma ◽  
Weighted Sequences

✓ Quadriplegia is a well-known complication of posterior fossa surgery performed while the patient is in the sitting position but is rarely associated with the prone position. A case of an 18-year-old man with a cerebellar medulloblastoma is described. There was no evidence of previous cervical disease. The patient suffered quadriplegia after undergoing surgery in the prone position. Postoperative magnetic resonance imaging demonstrated a long hyperintense C2—T1 lesion on T2-weighted sequences. The authors speculate that, during the prolonged period in which the neck was in hyperflexion, overstretching of the cervical spinal cord and compromise of its blood supply might have caused this devastating complication.

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