Advantages of the Prone Position for Neurosurgical Procedures on the Upper Cervical Spine and Posterior Cranial Fossa in Children

Humphreys, Robin P.; Creighton, R. E.; Hendrick, E B; Hoffman, H J

doi:10.1159/000119584

Cited by 7 publications

(4 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cardiovascular collapse during neurosurgical operations is not uncommon, especially in patients with large, vascular tumors, where blood loss can be torrential. 6,7 This is especially true in children undergoing neurosurgery, where profuse blood loss can cause life-threatening hemodynamic instability. Many of these operations are performed in the sitting, lateral, and prone positions, hindering conventional resuscitation and further compounding the dangers associated with cardiovascular instability.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation in the Lateral Position: Is It Feasible during Pediatric Intracranial Surgery?

Abraham¹,

Wadhawan²,

Gupta

et al. 2009

Anesthesiology

View full text Add to dashboard Cite

INTRAOPERATIVE cardiac arrest during neurosurgical operations can occur after massive blood loss in adults and in children. 1,2,3,4 Many of these procedures are performed in positions other than supine, and this could pose a major hurdle in successful resuscitation. 3 The practice of turning the patient supine for cardiopulmonary resuscitation (CPR) during neurosurgical operations has recently been questioned. 5 Although successful resuscitation has been reported in the prone position, there are no studies available on the feasibility of CPR in the lateral position. This is a case report of cardiac arrest due to massive blood loss in a child undergoing excision of a large brain tumor in the lateral position followed by successful resuscitation in the same position. Case ReportA 6-yr-old boy (height, 103 cm; weight, 18 kg) with clinical features of severe intracranial hypertension on ventilatory support was referred to this hospital for definitive management. Magnetic resonance imaging revealed a large and vascular right intraventricular tumor. The child suffered a cardiac arrest in the intensive care unit the day before surgery. He was successfully resuscitated and scheduled for emergency craniotomy under American Society of Anesthesiologists grade IV. On the day of surgery, his pulse rate was 130 beats per minute, blood pressure was 130/80 mmHG, and he was on pressure support ventilation. He had normal-sized pupils that were reacting to light and normal flexor motor response and spontaneous respiratory efforts. The child was placed in the left lateral decubitus position with the head resting on a doughnut for surgery. Intraoperative monitoring included intraarterial blood pressure and central venous pressure. During surgical decompression of the tumor, there was sudden and rapid blood loss associated with bradycardia (50 -60 beats per minute) and severe hypotension and hypovolemia (systolic blood pressure, 30 -40 mmHG; central venous pressure, -5 mmHG) followed by pulseless electrical activity. External cardiac massage was commenced in the lateral position itself using the two thumb-encircling hand technique to avoid any delay in resuscitation. This technique of CPR produced a pulsatile arterial trace and systolic pressures of approximately 50 -60 mmHG, Epinephrine boluses along with rapid transfusion of blood products and inotrope infusions (dopamine and adrenaline) were administered.Life-sustaining rhythm and blood pressure (70 -80 mmHG) were obtained within 3 min. One hour later, during hemostasis, the child had another episode of severe hypotension for which similar resuscitative measures were taken. After both episodes of successful resuscitation, the surgeon could proceed with tumor decompression and hemostasis. The surgery lasted 4 h and the blood loss was 1 l, which was replaced. At the end of surgery, he was shifted to the intensive care unit in a stable hemodynamic condition. Inotropic support was tapered off by the third postoperative day, and he was weaned off the ventilator on the eighth postoperati...

show abstract

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation in the Lateral Position: Is It Feasible during Pediatric Intracranial Surgery?

Abraham¹,

Wadhawan²,

Gupta

et al. 2009

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…For procedures in the pediatric patient it has been well shown that the prone position yields adequate exposure while substantially reducing the operative risks [5,6], The infratentorial approach in the prone position. while allowing and improving patient safety, is confounded in its exposure of the high cerebellum and parapineal region [8], A distinct disadvantage is the need to work over the superior aspect of the cerebellum and beneath the tentorium [8], Bridging cerebellar veins are encountered and must be interrupted [6,9], It is of interest that Cushing [3] described 2 cases of bleeding from this high cerebellar region via the infratentorial approach with 1 death.…”

Section: Discussionmentioning

confidence: 99%

“…The occipital transtentorial approach has been previously described by various authors for exposure of the pineal region [5,[7][8][9], With the introduction of the operating microscope the occipital approach allows relatively safe access to the previously difficult pineal region. It is our expe rience, however, that this procedure allows a good exposure of the superior part of the infratentorial compartment.…”

Section: Introductionmentioning

confidence: 99%

The Occipital Transtentorial Approach to the Posterior Fossa in the Pediatric Patient

Barba¹,

James

1984

Pediatr Neurosurg

View full text Add to dashboard Cite

show abstract

“…The chest is then supported on pillows or a foam pad. The full frame has been advocated by Humphries and colleagues [20] for use in neurosurgical procedures on the upper cervical spine and posterior fossa in children. Mouradian and Simmons [33] have described a method of combining the Foster or Stryker frame with the Relton and Hall frame so that continuous skeletal traction may still be applied whilst the patient is undergoing surgery.…”

Section: Influence Of Reconstructive Spinal Surgerymentioning

confidence: 99%

The Prone Position for the Surgical Patient: A Historical Review of the Principles and Hazards †

Anderton

1991

British Journal of Anaesthesia

View full text Add to dashboard Cite

Since the 1940s there has been an increase in the number of patients submitted for surgery of the spinal axis necessitating use of the prone position. Specifically designed operating tables were both rare and expensive, and probably only existed in a few highly specialized centres. Apparatus which could be easily made locally and used in conjunction with normal operating tables has been invented and generally used to good effect. The important historical landmarks in these developments are traced and a review of the methods and hazards is presented. Similar methods evolved almost simultaneously in differing centres. It is recommended that the Tarlov "seated prone" position should be widely used, in view of its physiological advantages and lack of adverse reports.

show abstract

Advantages of the Prone Position for Neurosurgical Procedures on the Upper Cervical Spine and Posterior Cranial Fossa in Children

Cited by 7 publications

References 11 publications

Cardiopulmonary Resuscitation in the Lateral Position: Is It Feasible during Pediatric Intracranial Surgery?

Cardiopulmonary Resuscitation in the Lateral Position: Is It Feasible during Pediatric Intracranial Surgery?

The Occipital Transtentorial Approach to the Posterior Fossa in the Pediatric Patient

The Prone Position for the Surgical Patient: A Historical Review of the Principles and Hazards †

Contact Info

Product

Resources

About