Semisitting Position for Posterior Fossa Decompression: A Safe Choice for High BMI Chiari I Malformation Patients

Introduction: Posterior fossa decompression (PFD) with or without duroplasty is the current standard treatment for patient with Chiari I malformation (CM). Prone positioning is the standard option but in patients with BMI over 40 kg/m², it poses a challenge for the surgical team. In this context, the semi-sitting position (SSP) can be an alternative.

Methods: We present three consecutives adult patients with symptomatic or progressive CM and high BMI (>40 kg/m²) that underwent surgery between 2020 and 2021. We excluded patients with cranio-cervical instability and basilar invagination. All patients underwent standard PFD with duroplasty and resection of the posterior arch of C1. Intraoperative transesophageal echocardiography was performed in all patients.

Results: Three female patients underwent PFD. The mean age was 37 years. The mean BMI was 51.59 kg/m². The positioning time was 5 to 10 minutes, and the mean operation time was 1.5 hours. The blood loss was inferior 50 cc in all procedures. No intraoperative complications were observed. The length of stay was 2 days, and no postoperative complications were noted.

Conclusion: Positioning is critical for PFD but may be challenging for high BMI patients. SSP is a safe and feasible choice for Chiari I malformation patients with BMI over 40 kg/m² ([Figs. 1] and [2]).

Fig. 1

Fig. 2

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022