Analytical Assessment of Perioperative Complications in Neurosurgical Procedures Performed in the Sitting Position

This study aimed to investigate the incidence and risk factors of perioperative complications in two types of neurosurgical procedures performed in the sitting position: deep brain stimulation (DBS) electrode placement and suboccipital craniotomy/craniectomy, with a focus on comparing their outcomes.

This retrospective analysis included 259 patients who underwent sitting-position neurosurgery (DBS electrode placement, n = 104; suboccipital craniotomy/craniectomy, n = 155) between January 2019 and June 2024. Complications, including venous air embolism (VAE), tension pneumocephalus, and hemorrhage, were analyzed separately for each group. Multivariate logistic regression and subgroup analyses were performed to identify independent risk factors specific to each procedure.

The overall complication rate was higher in suboccipital craniotomy/craniectomy (14.19%) than in DBS (5.77%). For DBS, diabetes (odds ratio (OR) = 6.000, p = 0.039) was identified as a key risk factor. For suboccipital craniotomy/craniectomy, independent risk factors included age ≥60 years (OR = 2.152, p = 0.006), diabetes (OR = 3.412, p = 0.020), heart disease (OR = 3.262, p = 0.048), American Society of Anesthesiologists (ASA) grade III (OR = 2.346, p = 0.007), and prolonged operative time (OR = 1.983, p = 0.015).

Neurosurgery in the sitting position demonstrates varying complication risks depending on surgical type and patient-specific factors. Strict perioperative monitoring and individualized positioning strategies are essential, particularly for elderly patients and those with comorbidities. These findings provide valuable insights for optimizing surgical safety and guiding future prospective studies.