Strategies to Prevent Positioning-Related Complications Associated with the Lateral Suboccipital Approach

Abstract

The lateral positioning used for the lateral suboccipital surgical approach is associated with various pathophysiologic complications. Strategies to avoid complications including an excessive load on the cervical vertebra and countermeasures against pressure ulcer development are needed. We retrospectively investigated positioning-related complications in 71 patients with cerebellopontine angle lesions undergoing surgery in our department between January 2003 and December 2010 using the lateral suboccipital approach. One patient postoperatively developed rhabdomyolysis, and another presented with transient peroneal nerve palsy on the unaffected side. Stage I and II pressure ulcers were noted in 22 and 12 patients, respectively, although neither stage III nor more severe pressure ulcers occurred. No patients experienced cervical vertebra and spinal cord impairments, brachial plexus palsy, or ulnar nerve palsy associated with rotation and flexion of the neck. Strategies to prevent positioning-related complications, associated with lateral positioning for the lateral suboccipital surgical approach, include the following: atraumatic fixation of the neck focusing on jugular venous perfusion and airway pressure, trunk rotation, and sufficient relief of weightbearing and protection of nerves including the peripheral nerves of all four extremities.

Keywords

lateral suboccipital approach - positioning-related complications - pressure ulcer - cerebellopontine angle tumor

• References

• 1 Kim LJ, Klopfenstein JD, Feiz-Erfan I, Zubay GP, Spetzler RF. Postoperative acute sialadenitis after skull base surgery. Skull Base 2008; 18 (2) 129-134
• 2 St-Arnaud D, Paquin MJ. Safe positioning for neurosurgical patients. Can Oper Room Nurs J 2009; 27 (4) 7-11 , 16, 18–19 passim
• 3 Toung TJ, McPherson RW, Ahn H, Donham RT, Alano J, Long D. Pneumocephalus: effects of patient position on the incidence and location of aerocele after posterior fossa and upper cervical cord surgery. Anesth Analg 1986; 65 (1) 65-70
• 4 Ausman JI, Malik GM, Dujovny M, Mann R. Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 1988; 29 (4) 298-306
• 5 Kikuta KI, Miyamoto S, Kataoka H, Satow T, Yamada K, Hashimoto N. Use of the prone oblique position in surgery for posterior fossa lesions. Acta Neurochir (Wien) 2004; 146 (10) 1119-1124 ; discussion 1124
• 6 Singha SK, Chatterjee N. Postoperative sialadenitis following retromastoid suboccipital craniectomy for posterior fossa tumor. J Anesth 2009; 23 (4) 591-593
• 7 Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol 2005; 63 (1) 5-18 ; discussion 18