Semisitting position in neurosurgery: A 20-year experience in a tertiary center.

Area of Science:

• Neurosurgery
• Surgical Positioning

Background:

• The semisitting position offers surgical advantages for posterior fossa and pineal region procedures.
• However, it is associated with potential complications such as venous air embolism (VAE) and tension pneumocephalus.

Purpose of the Study:

• To assess the safety, complication profile, and clinical outcomes of the semisitting position in neurosurgery.
• To evaluate the effectiveness of a standardized monitoring protocol over a 20-year period.

Main Methods:

• Retrospective cohort study of 244 patients undergoing neurosurgery in the semisitting position.
• Standardized monitoring protocol including Doppler ultrasonography, end-tidal CO2 monitoring, and central venous catheter.
• Systematic analysis of demographics, surgical details, complications (VAE, tension pneumocephalus), and outcomes.

Main Results:

• The incidence of VAE was 4.5%, with one fatal cerebral infarction.
• Other complications occurred in 3.6% of cases, including tension pneumocephalus (1.6%).
• Multivariate analysis did not identify significant predictors of complications.

Conclusions:

• The semisitting position is a safe and effective neurosurgical approach with rigorous protocols and vigilant monitoring.
• Risks associated with the semisitting position can be effectively mitigated.
• The semisitting position remains valuable for posterior fossa and pineal region surgeries.