The researchers wanted to look into the benefits and drawbacks of employing the semi-sitting posture in pediatric neurosurgery, with a particular focus on morbidity and surgical feasibility. They conducted a retrospective review of all pediatric cases at a single institution. The final analysis includes patients who underwent procedures in the semi-sitting posture between December 2010 and December 2020. They compared results for all those children who had posterior fossa lesions and had surgery in the prone position over the same time.
Between December 2010 and December 2020, they did 42 posterior fossa operations on 38 children in the semi-sitting position. The average patient was 8.9 years old (range 13 months–18 years). During the same time, they compared data of 24 procedures conducted in the prone position on 22 children. Preoperatively, three children (7.9%) were found to have a chronic foramen ovale. In all cases, the surgery was finished. A venous air embolism (VAE) occurred 11.9% of the time. Hemodynamic instability, infarction, or death were not linked to VAE. In 14 cases, they used endoscopic procedures (33.3%). Patients who underwent procedures in the semi-sitting position showed significantly higher rates of postoperative pneumocephalus (p < 0.05) but no need for intervention. Due to using a skull clamp during one surgery (2.4%), the patient suffered a postoperative skull fracture and epidural hemorrhage.
In 33 of the 42 procedures conducted in the semi-sitting position (78.6%), the patients’ clinical state improved or remained stable immediately after surgery. The semi-sitting posture is safe for posterior fossa surgery in the juvenile population when performed with care and an experienced surgical team. The semi-sitting stance, which has a similar complication profile, provides excellent anatomical exposure, suitable for endoscopic viewing. The use of a careful skull clamp and proper monitoring is highly suggested.
Reference:thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/28/6/article-p724.xml
