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CC BY 4.0 · J Neuroanaesth Crit Care
DOI: 10.1055/s-0045-1811704
Original Article

Perioperative Complications During Posterior Fossa Surgery in Sitting Position: A Single-Center Retrospective Study

Authors

  • Arjun Balakrishnan 

    1   Department of Anaesthesiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal Karnataka, India
    2   Department of Neuroanaesthesiology and Neurocritical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

  • Ashish Bindra

    2   Department of Neuroanaesthesiology and Neurocritical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India

  • Girija P. Rath 

    2   Department of Neuroanaesthesiology and Neurocritical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Abstract

Background

Sitting position used to be a favored position for posterior fossa surgery. Its use has declined owing to the increased incidence of life-threatening complications. Our center continues to practice sitting craniotomy, although less frequently. This study aimed to determine the incidence of perioperative complications during sitting craniotomy.

Methods

Medical records of 206 patients who underwent posterior fossa surgery in sitting position over a 10-year period were analyzed. Data on demographics, perioperative complications, and neurological status were recorded. Statistical analysis was done using the chi-square and the Wilcoxon rank-sum tests, and a p-value of < 0.05 was considered significant.

Results

Out of 206 eligible patients, 188 had near-complete data. A declining trend was observed in the use of the sitting position. Thirty-nine patients presented with episodes of venous air embolism (VAE) with an incidence of 20.7%. No correlation was found between cerebrospinal fluid draining procedures or previous craniotomy and the development of VAE. None of the patients reported other perioperative complications except one who developed tension pneumocephalus. Intraoperative brainstem handling was the most common reason (72%) for postoperative mechanical ventilation. At discharge, 166 (88.3%) patients had good neurological outcomes, while poor outcomes were seen in 4 and mortality in 15 (7.9%), respectively.

Conclusion

The incidence of perioperative complications with the sitting position was not unusually high to prevent its routine use. Moreover, the development of VAE was not associated with increased complications or patient mortality risk. The use of sitting craniotomy, while debatable, continues to be safe in expert hands.

Keywords

venous air embolism - neurosurgery - sitting craniotomy


Publication History

Article published online:
18 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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