Abstract
Background For surgery of brain metastases, good immediate postoperative functional outcome
is of utmost importance. Improved functional status can enable further oncologic therapies
and adverse events might delay them. Pros and cons of either sitting or prone positioning
for resective surgery of the posterior fossa are debated, but contemporary data on
direct postoperative outcome are rare. The aim of our study was to compare the functional
outcome and adverse events of surgery for brain metastases in the sitting versus the
nonsitting position in the direct postoperative setting.
Methods We retrospectively compared surgery of metastases located in the posterior fossa
over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery
exclusively in the sitting, while center 2 performed surgery only in the nonsitting
position.
Results Worse functional outcome (Karnofsky performance scale) and functional deterioration
were seen in the “sitting” group. We found significantly more “sitting” patients to
deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases
in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated
with worse outcome and more adverse events.
Conclusion Therefore, we recommend the nonsitting position for surgery of brain metastases of
the posterior fossa.
Keywords
sitting position - prone position - posterior fossa - neurosurgical technique
