Compartment syndrome and rhabdomyolysis as a positioning complication following retrosigmoid craniotomy

The goal of surgical positioning is to provide optimal surgical access and visualization while maintaining the patient's safety, with the least physiological compromise. Here, we report a 30-year-old man with an unremarkable past medical history who developed superior vena cava syndrome after a 15-hour retrosigmoid craniotomy for removal of a right cerebellopontine (CP) angle tumor. Compartment syndrome from the head to neck and rhabdomyolysis were recognized, with extensive swelling of his head and neck, markedly swollen soft tissues and necrosis of multiple muscles revealed by computed tomography, and very high concentrations of creatine kinase (CK) and aspartate transaminase. Immediate intensive care and rehabilitation therapy were provided and aimed at maintaining adequate perfusion/oxygenation and decreasing tissue pressure. He was successfully weaned from ventilation on postoperative day (POD) 25, transferred to a general ward on POD 29, and discharged with mild muscular and neurological sequelae on POD 51. Careful adjustment of surgical positioning is crucial for patient safety, especially when positioned at an extreme position in association with prolonged surgery.