[Patient positioning on the operating table in neurosurgery: sitting or lying]

Area of Science:

• Neurosurgery
• Surgical Positioning

Background:

• Trigeminal neuralgia is a debilitating condition often treated with microvascular decompression (MVD).
• Patient positioning during MVD surgery can influence surgical outcomes and complication rates.

Purpose of the Study:

• To evaluate the efficacy and safety of microvascular decompression for trigeminal nerve based on patient positioning.
• To compare complication rates associated with lying versus sitting positions during MVD surgery.

Main Methods:

• Retrospective observational study of 200 neurosurgical patients undergoing MVD.
• Analysis of complication rates and neurological outcomes in relation to patient position (lying vs. sitting).

Main Results:

• Surgical efficacy of MVD is not dependent on patient positioning.
• The lying position eliminated risks of postural hypotension, surgical hypotension, tension pneumocephalus, and peripheral nerve injury.
• The sitting position increased the risk of air venous embolism by 25 times.
• The lying position increased the risk of postoperative nasal liquorrhea by 4 times but eliminated the risk of postoperative trigeminal nerve paresis.
• The lying position decreased risks of corneal reflex reduction, hyperpathia, and paresthesias, while increasing postoperative hyperesthesia risk by 4 times.

Conclusions:

• Microvascular decompression of the trigeminal nerve yields similar efficacy regardless of patient positioning.
• The lying position is demonstrably safer for MVD surgery due to a significantly lower risk profile for major complications compared to the sitting position.