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Sitting or prone? Another argument for the latter

Z Kalenda, P N Greuter

    Acta Neurochirurgica
    |January 1, 1982
    PubMed
    Summary
    This summary is machine-generated.

    A pediatric craniectomy for cerebellar ependymoma was complicated by circulatory arrest. External cardiac massage, performed without repositioning, successfully managed the event, highlighting the prone position

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    Area of Science:

    • Pediatric Neurosurgery
    • Neuro-oncology
    • Critical Care Medicine

    Background:

    • Cerebellar vermis ependymomas can invade the fourth ventricle, posing surgical challenges in pediatric patients.
    • Craniectomy in the prone position is a common surgical approach for posterior fossa tumors.
    • Potential complications include hemodynamic instability and circulatory compromise.

    Observation:

    • A one-year-old child underwent prone craniectomy for a fourth ventricle-invading ependymoma.
    • Circulatory arrest occurred intraoperatively.
    • External cardiac massage was initiated without altering the patient's prone position.

    Findings:

    • Successful resuscitation was achieved via external cardiac massage in the prone position.
    • The surgical procedure was completed satisfactorily following circulatory restoration.

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  • Capnography proved valuable in monitoring circulatory adequacy during the event.

    • Implications:

    • The prone position may offer advantages during management of intraoperative circulatory arrest compared to the sitting position.
    • Continuous capnography is crucial for real-time assessment of cerebral perfusion and guiding resuscitation efforts.
    • This case underscores the importance of preparedness for managing critical events during complex pediatric neurosurgery.