Patient positioning for the operative approach to midline intracerebral lesions: technical note

Patients undergoing craniotomies for intracerebral lesions are generally positioned in such a way that the lesion is highest in the field. For midline lesions alongside the falx, patients are commonly positioned on their backs for an anatomically symmetrical approach. We propose positioning the patient in the lateral decubitus position ipsilateral to the lesion to take advantage of gravity by allowing the brain to fall away from the midline, thus obviating the need for retraction. We have used this position in 15 cases of falcine and parafalcine tumors to great advantage, without encountering untoward operative or anesthetic complications.