Lateral semisitting position [Neurosurgery Wiki]

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====== Lateral semisitting position ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1TehQ7T6jkw1zguBwrdHXtEl0x6o737et-Amxl5HSdrfyekEwy/?limit=15&utm_campaign=pubmed-2&fc=20230601171609}}
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The lateral [[semisitting position]] involved placing the patient in a lateral position first (side of tumor up) followed by flexing the torso to 45° and tilting the head toward the opposite shoulder by 20°. This was done to the point where the zygomatic arch is almost parallel to the floor. The chin should be 2 finger breadths away from the sternum as extreme flexion would compromise venous return from the head. The distance was kept between the planned incision and the patient's ipsilateral shoulder, which will otherwise limit the surgeon's range of motion later in the case
((Velho V, Naik H, Bhide A, Bhople L, Gade P. Lateral Semi-sitting Position: A Novel Method of Patient's Head Positioning in Suboccipital Retrosigmoid Approaches. Asian J Neurosurg. 2019 Jan-Mar;14(1):82-86. doi: 10.4103/ajns.AJNS_203_17. PMID: 30937014; PMCID: PMC6417342.)).
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The risk of [[venous air embolism]] (VAE) is the major deterrent for surgeons and anesthesiologists, despite the fact that [[sitting position]] and [[semisitting position]]s are commonly used in these [[operation]]s.

To demonstrate a reduction in the risk of VAE and [[tension pneumocephalus]] throughout the [[operation]] period while taking [[advantage]] of the [[semisitting position]].

In a study, 11 patients with various diagnoses were operated on the Department of Neurosurgery, Ondokuz Mayis University, School of Medicine, Samsun, Turkey using the supracerebellar approach in the dynamic [[lateral semisitting position]]. They used end-tidal carbon dioxide and [[arterial blood pressure]] [[monitoring]] to detect [[venous air embolism]].

None of the patients had clinically significant VAE in this study. No [[tension pneumocephalus]] or major [[complication]]s were observed. All the patients were extubated safely after surgery.

The ideal [[position]], with which to apply the [[supracerebellar approach]], is still a challenge. In the study, Durmuş et al. presented an alternative [[position]] that has the [[advantage]]s of [[sitting]] and [[semisitting position]]s with a lower risk of [[venous air embolism]]
((Durmuş YE, Kaval B, Demirgil BT, Gökalp E, Gurses ME, Varol E, Gonzalez-Lopez P, Cohen-Gadol A, Gungor A. Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series. Oper Neurosurg (Hagerstown). 2023 May 31. doi: 10.1227/ons.0000000000000758. Epub ahead of print. PMID: 37255298.)).