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 supine positioning for resective surgery of the posterior fossa are debated but contemporary data on direct postoperative outcome is rare. Aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in sitting vs. non sitting position in the direct postoperative setting. We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Either center performed surgery exclusively in sitting or non-sitting positioning respectively. Worse functional outcome (Karnofsky Performance scale) and functional deterioration was seen in the “sitting” group (coming from higher functional scores). We found significantly more “sitting” patients to deteriorate to a KPS ≤60% including four deaths (vs. one in non-sitting position). In this study, treating patients with brain metastases in sitting position resulted in a number needed to harm (NNH) of 2.3. In this study, we found sitting position for surgery of brain metastases to be associated with worse outcome and more adverse events. Therefore, we tend to recommend non-sitting over sitting position for surgery of brain metastases of the posterior fossa.
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