New head-prone position for posterior fossa surgery in infants with severe hydrocephalus

A new head-prone position is described for posterior cranial fossa surgery on infants whose cerebral cortical mantle has been markedly thinned by severe hydrocephalus. The new position furnished a direct line of sight to the apex of the IV ventricle corresponding to that provided by the classic high sitting position, without the latter's risks of air embolism and of acute subdural hematoma secondary to tearing of corticodural bridging vessels due to escape of gravity-impelled CSF from the large ventricles. The anesthesiologic technique, the positioning of the patient, and the surgeon's posture presented no unusual problems.