The Sitting Position in Neurosurgery: A Clinical Study in 96 Cases

Introduction: Sitting position for operation of posterior fossa lesions, occipital and posterior parietal lesions, foramen magnum, upper cervical spinal lesions provides an excellent visualization because of slack of brain because of gravity drainage of CSF and blood. Hence, gross total tumor removal relatively easy and less complicated.

Methods: From January 2008 to August 2014, a total 96 cases underwent neurosurgical procedure in sitting position. Physical characteristics including patient age, sex, size of the tumor, and histological diagnosis were collected.

Results: There was 45 male and 51 female patients. Ages varies from 10 to 70 years. Mean age was 40 years. Presentations were headache in 64 cases, ataxia in 69 cases, vomiting in 49 cases, deafness in 43 cases, dyspepsia in 7 cases, facial weakness in 9 cases, quadriparesis in 3 cases, six nerve palsy in 3 cases, aspiration pneumonia in 2 cases, and paresthesia in 2 cases. The postoperative image were studied to see the extent of tumor removal and early detection of complications. Extent of tumor removal was gross total in 61 cases, subtotal in 18 cases, near-total in 16 cases, and partial in 1 case. Size of tumor were 3 mm in 8 cases, 4 mm in 11 cases, 5 mm in 35 cases, and 6 mm or above in 41 cases. Diagnoses of patients were vestibular schwannoma in 61 cases, petroclival meningioma in 13 cases, tentorial meningioma in 7 cases, pineal region tumor in 3 cases, cerebellar glioma in 2 cases, nonvestibular schwannoma in 2 cases, epidermoid in 2 cases, upper cervical schwannoma in 1 case, posterior thalamic glioma in 1 case, enterogenous cyst in 1 case, medial practral ADM in 1 case, and Vermin tumor and clival chordoma in 1 case. All most all the patients required peroperative CV line or peripheral inserted central venous line, precordial Doppler sound, ETCO₂, O₂ saturation, and close monitoring of blood pressure. Venous air embolism were detected in two cases. There were six mortality in 96 cases. Three cases from CP angle tumor, two cases from petroclival meningioma, and another one case from pineal region tumor. There were pneumocephalus in almost all cases and postoperative new facial nerve palsy in 51 cases, hemorrhage developed in 26 cases, fifth nerve palsy developed in 4 cases, hydrocephalus in 3 cases, temporary lower cranial nerve palsy developed in 1 case, Septicemia in 1 case, VP Shunt in 1 case, and hernia in 1 case. Most of the patient have good outcome (GOS 5).

Conclusion: Sitting position can be safely done with good preoperative physiological, peroperative close monitoring of the patient regarding blood pressure, ETCO₂, and oxygen saturation. However, postoperative complications such as tumor bed hematoma, pneumocephalus, and cranial nerve palsy have to be considered.