Tag: Semi-sitting position

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Impact of patient positioning on bleeding rate in stereotactic brain biopsies: semi‑sitting versus supine position

Acta Neurochirurgica (2025) 167:159

The study found that using a semi-sitting position (30° head elevation) during stereotactic brain biopsies significantly reduced the rate of hemorrhagic complications compared to the supine position, suggesting patient positioning is a key, modifiable factor for improving safety and outcomes in these neurosurgical procedures.

• Study compared bleeding rates in stereotactic brain biopsies between semi-sitting and supine positions.

• Retrospective analysis of 78 patients: 39 semi-sitting, 39 supine.

• Hemorrhagic complications were significantly lower in the semi-sitting group (7.7%) vs supine (33.3%).

• Semi-sitting position is a potential protective factor against bleeding (OR 0.17, p=0.009).

• Groups were similar in age, sex, tumor type, and biopsy site; more samples were taken in semi-sitting group.

• No symptomatic bleedings occurred in either group.

• Semi-sitting position may reduce intracranial venous pressure, lowering bleeding risk.

• Authors recommend further prospective, multicenter studies to validate findings.

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Paramedian supracerebellar transtentorial approach for a temporomesial glioma

Acta Neurochirurgica (2021) 163:1311–1316

Classical approaches to the temporomesial region (TMR) include transtemporal, transylvian, or subtemporal. The supracerebellar infratentorial, initially developed to access dorsolateral cavernomas, has of late shown its versatility to access areas around the central core. The TMR is one such area that can be accessed through this approach with the addition of a tentorial incision.

Method The paramedian supracerebellar transtentorial approach (PSCTA) is described along with its advantages and limits compared to other approaches to treat TMR gliomas.

Conclusion The PSCTA offers a basal panoramic view of the TMR without the need of retraction, cortical incision, and white matter transgression.

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Venous air embolism in the sitting position in cranial neurosurgery

Acta Neurochir (2017) 159:339–346

There is an ongoing debate about the sitting position (SP) in neurosurgical patients. The SP provides a number of advantages as well as severe complications such as commonly concerning venous air embolism (VAE). The best monitoring system for the detection of VAE is still controversial.

Methods: In this retrospective analysis we compared 208 patients. Transesophageal echocardiography (TEE) or transthoracic Doppler (TTD) were used as monitoring devices to detect VAE; 101 cases were monitored with TEE and 107 with TTD.

Results: The overall incidence of VAE was 23% (TTD: 10%; TEE: 37%), but the incidence of clinically relevant VAE (drop in end-tidal carbon dioxide above 3 mmHg) was higher in the TTD group (9 out of 17 VAE, 53%) compared to the TEE group (19 out of 62 VAE, 31%). None of the patients with recorded VAE had clinically significant sequelae.

Conclusions: In this small sample we found more VAE events in the TEE group, but the incidence of clinically relevant VAE was rare and comparable to other data. There is no consensus in the definition of clinically relevant VAE.

 

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