THE SITTING POSITION FOR NEUROSURGERY - T HE SURGICAL POINT-OF-VIEW

The sitting position offers the benefits of better access to the apex of the posterior fossa, and an improved exploration and dissection bec ause blood and cerebral spinal fluid drain away from the operative sit e. Specific complications of the sitting position include cardiovascul ar instability, jugular venous obstruction, airway oedema, quadriplegi a, displacements of catheters and the endotracheal tube, ulnar, sciati c and lateral peroneal nerve compression, venous air embolism, and ten sion pneumocephalus. In the only existing comparative study, the diffe rences were an increased bleeding in the horizontal position and a bet ter cranial nerve presentation in the sitting position. This argues st rongly for teaching and use of the sitting position whenever surgicall y indicated. (C) 1998 Elsevier, Paris.