Surgery in the Semi-Sitting Position: A Worldwide Survey among Neurosurgeons

The semi-sitting position in neurosurgery remains a topic of debate. Despite advantages such as improved surgical accessibility and visibility, it is associated with risks such as venous air embolism. This study provides an overview of the current use, benefits, challenges, and future prospects of the semi-sitting position, based on insights from a sample of international neurosurgeons.

A structured questionnaire was distributed via social media channels to neurosurgeons worldwide, collecting data on demographics, usage frequency, indications, reasons for use or nonuse, feared complications, alternative positions, and treated pathologies. Responses from 141 neurosurgeons were analyzed, comparing developed and developing countries.

Overall, 81.6% of neurosurgeons reported using the semi-sitting position, with a significantly higher frequency in developed countries (p < 0.001). A total of 97.9% of participants used this position for infratentorial pathologies. Major barriers included fear of complications (44.3%), insufficient anesthesia team training (42.9%), and lack of appropriate equipment (31.4%). Significant regional differences were observed, with training deficits (p = 0.007), lack of equipment (p = 0.001), and limited experience (p = 0.008) reported more frequently in developing countries. Perioperative monitoring practices showed variability; however, most modalities did not differ significantly between groups, including intraoperative transesophageal echocardiography (p = 0.091). Among nonusers, 44% expressed willingness to adopt the semi-sitting position with appropriate training and support.

Despite its challenges, the semi-sitting position offers significant advantages for specific neurosurgical procedures. Successful implementation requires an experienced surgical and anesthesiology team. Efforts to enhance training, improve technology, and provide adequate infrastructure could facilitate broader adoption of the semi-sitting position.