Patient Positioning in Neurosurgery, Principles and Complications

Adrian Balasa 1 , Corina Ionela Hurghis 2 , Flaviu Tamas 2  and Rares Chinezu 1 , 2
  • 1 George Emil Palade University of Medicine, Romania
  • 2 Neurosurgery Clinic, Emergency County Hospital, Targu Mures, Romania

Abstract

Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist. Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.

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  • 1. Rozet I, Vavilala MS − Risks and Benefits of Patient Positioning During Neurosurgical Care. Anesthesiol Clin. 2007;25:631-653.

  • 2. Sivakumar S, Taccone FS, Desai KA et al. − ESICM LIVES 2016: part two. Intensive Care Med Exp 2016;4:30.

  • 3. El-Zenati H, Faraj J, Al-Rumaihi G − Air embolism related to removal of Mayfield head pins. Asian J Neurosurg. 2013;7:227.

  • 4. Kim I, Storm RG, Golfinos JG − Positioning for Cranial Surgery, Couldwell WT, Misra BK, Seifert V, Ture U (eds): Youmans & Winn Neurological Surgery, Elsevier, Philadelphia, PA, 2017, 240.

  • 5. Awad AJ, Zaidi HA, Albuquerque FC, Abla AA − Gravity-Dependent Supine Position for the Lateral Supracerebellar Infratentorial Approach. Oper Neurosurg. 2016;12:317-325.

  • 6. Koizumi H, Utsuki S, Inukai M, Oka H, Osawa S, Fujii K − An Operation in the Park Bench Position Complicated by Massive Tongue Swelling. Case Rep Neurol Med. 2012;2012:1-4.

  • 7. Yamaguchi T, Uchino S, Kaku S et al. − Delayed Airway Obstruction after Craniotomy in the Park-Bench Position: Two Case Reports. J Anesth Pain Med. 2017;2:2-5.

  • 8. Kwee MM, Ho YH, Rozen WM − The prone position during surgery and its complications: A systematic review and evidence-based guidelines. Int Surg. 2015;100:292-303.

  • 9. Nanjangud P, Nileshwar A, − Cardiopulmonary resuscitation in adult patients in prone position. Indian J Respir Care. 2017;6:791.

  • 10. Mazer SP, Weisfeldt M, Bai D et al. − Reverse CPR: A pilot study of CPR in the prone position. Resuscitation. 2003;57:279-285.

  • 11. Ausman JI, Malik GM, Dujovny M, Mann R, − Three-quarter prone approach to the pineal-tentorial region. Surg Neurol. 1988;29:298-306.

  • 12. Himes BT, Mallory GW, Abcejo AS et al. − Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg. 2016;127:182-188.

  • 13. Korkmaz Dilmen O, Akcil EF, Tureci E et al. − Neurosurgery in the sitting position: Retrospective analysis of 692 adult and pediatric cases. Turk Neurosurg. 2011;21:634-640.

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