Complications related to positioning in posterior fossa craniectomy

To compare complications associated with surgical position, a retrospective study was conducted on 260 patients who underwent posterior fossa craniectomy. Data collected from the records included demographic profile, American Society of Anesthesiologists' physical status score, neurological status, cranial nerve involvement, associated medical illnesses, anaesthetic technique, patient position, haemodynamic changes, duration of surgery, venous air embolism (VAE), blood loss/transfusion, postoperative complications, duration of ICU stay, and postoperative neurological status. Statistical analysis was done using the Chi-square test and independent t-tests. The demographic profile and preoperative associated medical illnesses of patients were comparable between groups. The incidence of end-tidal carbon dioxide (EtCO2) detected VAE was more (p=0.00) in the sitting position than the horizontal positions (15.2% vs. 1.4%). Blood loss/transfusion and the duration of surgery were significantly higher in the horizontal position (p<0.05). Brainstem handling was the most common cause of prolonged postoperative mechanical ventilation and was seen more in the sitting position. Lower cranial nerve functions were preserved better in the sitting position (p<0.05). Most postoperative complications (surgical or otherwise) were comparable between the groups (p>0.05). Most patients in both groups developed mild-to-moderate disability with independent lifestyle at the seventh postoperative day. To conclude, both sitting and horizontal positions can be used safely in posterior fossa surgeries.