Background: The most common methods of positioning patients for suboccipital approaches are the
lateral, lateral oblique, sitting, semisitting, supine with the head turn, and park
bench. The literature on the positioning of patients for these approaches does not
mention the use of lateral semisitting position. This position allows utilization
of the benefits of both semisitting and lateral position without causing any additional
morbidity to the patient. Aims: The aim of the present study is to highlight the advantages of the lateral semisitting
position while operating various cerebellopontine angle (CPA) and posterior fossa
lesions. Materials and Methods: The position involved placing the patient in a lateral position with torso flexed
to 45° and head tilted toward opposite shoulder by 20°. The most common approach taken
was retrosigmoid suboccipital craniotomy. Results: The advantages of lateral semisitting position were early decompression of cisterna
magna, and the surgical field remained relatively clear, due to gravity-assisted drainage
of blood and irrigating fluid. We could perform all the surgeries without the use
of any retractors. The position allowed better delineation of surrounding structures
resulting in achieving correct dissection plane and also permitted early caudal to
cranial dissection of tumor capsule, thereby increasing chances of facial nerve preservation.
Importantly, there is less engorgement of the cerebellum as the venous outflow is
promoted. We have not experienced any increased rate of complications, such as venous
air embolism, tension pneumocephalus with this lateral semisitting position. Conclusions: Lateral semisitting position is a relatively safe modification, which combines the
benefits of semisitting and lateral position, and avoids the disadvantages of sitting
position in operating CPA tumors. This position can provide quick and better exposure
of the CPA without any significant complications.
Key-words:
Cerebellopontine angle - lateral semisitting position - retractor less surgery
