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Awake surgery in sitting position for chronic subdural hematoma
Milan Lepić1,2,3, Stefan Mandić-Rajčević4, Goran Pavlićević1,2
1Medical Faculty of the Military Medical Academy, University of Defence, Belgrade, Serbia.
Acta Neurochirurgica
|January 19, 2021
Summary
This study found that surgically treating chronic subdural hematoma (CSDH) in the sitting position is safe, with no position-related complications. This neurosurgery technique offers potential benefits for patients and surgeons.
Area of Science:
- Neurosurgery
- Surgical Procedures
- Patient Outcomes
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly in the elderly.
- The incidence of CSDH is projected to double in the coming decade.
- The sitting position offers potential advantages for CSDH surgery, including improved patient and surgeon comfort.
Purpose of the Study:
- To detail the technical aspects of performing CSDH surgery in the sitting position.
- To evaluate the safety of the sitting position for CSDH procedures.
- To discuss the benefits and drawbacks of this surgical modification.
Main Methods:
- A series of 55 patients with CSDH underwent surgical treatment in the sitting position.
- Outcomes were assessed over a 6-month follow-up period, defining success as CSDH and symptom resolution.
- Complications, including pneumocephalus and those specific to the sitting position, were meticulously recorded.
Main Results:
- No complications specifically related to the sitting position were observed.
- Significant improvements in Glasgow Coma Scale and Markwalder Grading Scale scores were noted post-surgery.
- Overall complication rate was 30.9%, with 16.4% mortality within 6 months.
Conclusions:
- The sitting position was well-tolerated, even by severely ill patients.
- No adverse events linked to the sitting position occurred in this series.
- Further research is warranted to confirm the safety and explore the advantages of the sitting position in CSDH surgery.
