Patient Positioning in Neurosurgery, Principles and Complications

Abstract

Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist. Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.

Neuroanaesthetic challenges in a pregnant patient with a huge cerebellopontine angle meningioma

“…The retrosigmoid approach and Park-bench position will give the best operative window and comfort to the surgeon to arrive at the tumour. In the case of our pregnant patient, it is a blessing in disguise, as the Park-bench position avoided the abdominal aorta compression which can reduce uteroplacental supply to the fetus 10 11. Meanwhile, in lateral position, the ipsilateral shoulder of the patient will hinder the best operative field of the surgeon as it will restrict and limit the flexibility of the operative space to the surgeon to get to the tumour.…”

Nursing Care Related with Surgical Position

“…For this purpose, numerous positions have been devised to keep the head above the horizontal plane, and technological refinements to fix the bone plane and maintain the position during the execution of microscopic maneuvers. (27) It is also used for orthopedic procedures requiring access to the shoulder. An advantage of this position for shoulder surgery is that, when performed laparoscopically, it allows the procedure to be in an open approach and is easier than if the patient were in the lateral decubitus position.…”

“…For this purpose, numerous positions have been devised to keep the head above the horizontal plane, and technological refinements to fix the bone plane and maintain the position during the execution of microscopic maneuvers. 27 …”

Perioperative Positioning in Neurosurgery: A Technical Note on Park Bench Positioning for the Obese Patient Using the “Arrowhead” Technique

“…Common positioning techniques that provide access to the posterior fossa traditionally include the lateral, prone, and semi-seated positions. Many factors can contribute to the surgeon’s choice of a particular positioning method, to include the surgeon’s training, clinical experience, and personal preferences [ 1 ]. Even seemingly small changes in the location of intracranial mass lesions, arteriovenous malformations, and dural fistulas can require a more nuanced trajectory and alterations in patient positioning.…”