Joham Choque-Velasquez1, Roberto Colasanti2, Julio C Resendiz-Nieves3, Kléber E Gonzáles-Echevarría3, Rahul Raj3, Behnam Rezai Jahromi3, Felix Goehre4, Ann-Christine Lindroos3, Juha Hernesniemi3. 1. Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: johchove@hotmail.com. 2. Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy. 3. Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. 4. Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Stroke Center, Bergmannstrost Hospital Halle, Halle, Germany.
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° 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 <45 minutes in most of the cases. Postoperative pneumocephalus was detected in all patients, but no case required surgical treatment. 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.
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° 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 <45 minutes in most of the cases. Postoperative pneumocephalus was detected in all patients, but no case required surgical treatment. 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.
Authors: Joham Choque-Velasquez; Julio C Resendiz-Nieves; Behnam Rezai Jahromi; Roberto Colasanti; Rahul Raj; Kenneth Lopez-Gutierrez; Olli Tynninen; Mika Niemelä; Juha Hernesniemi Journal: Surg Neurol Int Date: 2019-06-19