Praying Sitting Position for Pineal Region Surgery : An Efficient Variant of a Classic Position in Neurosurgery

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Choque-Velasquez , J , Colasanti , R , Resendiz-Nieves , J C , Gonzales-Echevarria , K E , Raj , R , Jahromi , B R , Goehre , F , Lindroos , A-C & Hernesniemi , J 2018 , ' Praying Sitting Position for Pineal Region Surgery : An Efficient Variant of a Classic Position in Neurosurgery ' , World Neurosurgery , vol. 113 , pp. E604-E611 . https://doi.org/10.1016/j.wneu.2018.02.107

Title: Praying Sitting Position for Pineal Region Surgery : An Efficient Variant of a Classic Position in Neurosurgery
Author: Choque-Velasquez, Joham; Colasanti, Roberto; Resendiz-Nieves, Julio C.; Gonzales-Echevarria, Kleber E.; Raj, Rahul; Jahromi, Behnam Rezai; Goehre, Felix; Lindroos, Ann-Christine; Hernesniemi, Juha
Contributor: University of Helsinki, Clinicum
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
Date: 2018-05
Language: eng
Number of pages: 8
Belongs to series: World Neurosurgery
ISSN: 1878-8750
URI: http://hdl.handle.net/10138/302419
Abstract: BACKGROUND: The sitting position has lost favor among neurosurgeons partly owing to assumptions of increased complications, such as venous air embolisms and hemodynamic disturbances. Moreover, the surgeon must assume a tiring posture. We describe our protocol for the "praying position" for pineal region surgery; this variant may reduce some of the risks of the sitting position, while providing a more ergonomic surgical position. METHODS: A retrospective review of 56 pineal lesions operated on using the praying position between January 2008 and October 2015 was performed. The praying position is a steeper sitting position with the upper torso and the head bent forward and downward. The patient's head is tilted about 30 degrees making the tentorium almost horizontal, thus providing a good viewing angle. G-suit trousers or elastic bandages around the lower extremities are always used. RESULTS: Complete lesion removal was achieved in 52 cases; subtotal removal was achieved in 4. Venous air embolism associated with persistent hemodynamic changes was nonexistent in this series. When venous air embolism was suspected, an immediate reaction based on good teamwork was imperative. No cervical spine cord injury or peripheral nerve damage was reported. The microsurgical time was CONCLUSIONS: A protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.
Subject: Air embolism
Ergonomics
Hemodynamics
Microneurosurgery
Pineal region lesions
Sitting position
Supracerebellar infratentorial approach
VENOUS AIR-EMBOLISM
SUBOCCIPITAL RETROSIGMOID APPROACH
EXPERIENCE
MANAGEMENT
COMPLICATIONS
ANESTHESIA
PRESSURE
PROTOCOL
LESIONS
PERU
3126 Surgery, anesthesiology, intensive care, radiology
3112 Neurosciences
3124 Neurology and psychiatry
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