The lateral supracerebellar approach is not ideal for midline lesions. In thedynamic lateral semisitting position, lateral supracerebellar, midline supracerebellar, and retrosigmoid approaches can be applied. In a study about the occurrence and management of postoperative pneumocephalus using the semisitting position by Machetanz et al, tension pneumocephalus was reported in 3.3% of 429 patients in the semisitting position. In the study, of Durmuş et al. they did not detect tension pneumocephalus in any of the patients. It is possible that the number of patients in the study is insufficient to conclude on tension pneumocephalus; however, they think that placing the patient from the lateral semisitting position to the lateral decubitus position during the dura mater suturing stage might play a role in preventing the tension pneumocephalus by increasing the intracranial pressure in this final step of the surgery. J. H. Palazón et al. reported that mean cerebral perfusion pressure values fell slightly when the head was elevated to 30° (3.5 mm Hg) compared with the supine position, and a greater reduction was achieved when the head was elevated 45° (7.1 mm Hg) compared with the supine position.

While performing the supracerebellar approach using the dynamic lateral semisitting position, placing the patient in the lateral decubitus position during the dural and extradural stages, probably increases the cerebral perfusion pressure. This manipulation can protect the cerebral tissue against possible hemodynamic changes. Another benefit of the dynamic lateral semisitting position is that the surgeon can combine retrosigmoid and supracerebellar approaches with a simple manipulation on back section angle of the operating table. Although the number of our cases is small, we think that the dynamic lateral semisitting position, which we apply safely in various localizations and pathologies, can be an alternative to other positions used in supracerebellar approaches. The safety of this position can be tested by using it in more cases in the future ¹⁾