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The safety and utility of the semi-sitting position for clipping of posterior circulation aneurysms

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Title: The safety and utility of the semi-sitting position for clipping of posterior circulation aneurysms
Authors: Al-Afif, Shadi, Lang, Josef M., Abdulbaki, Arif, Palmaers, Thomas, Scheinichen, Dirk, Abu-Fares, Omar, Hermann, Elvis J., Krauss, Joachim K.
Source: Acta Neurochir (Wien)
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Male, Adult, Sitting Position, Research, Intracranial Aneurysm, Middle Aged, Subarachnoid Hemorrhage, Surgical Instruments, Neurosurgical Procedures, 3. Good health, 03 medical and health sciences, Treatment Outcome, 0302 clinical medicine, Humans, Female, SAHsubarachnoid hemorrhage, PFOpatent foramen ovale, PICA aneurysm, Aged [MeSH], SSEPs somatosensory evoked potentials, ICUintensive care unit, Venous air embolism, Clipping, CTcomputer tomography, TTEtransthoracic echocardiography, Male [MeSH], Subarachnoid Hemorrhage/surgery [MeSH], EtCO2end-tidal carbon dioxide, Sitting Position [MeSH], Semi-sitting position, Female [MeSH], Adult [MeSH], Abbrevations, Humans [MeSH], Treatment Outcome [MeSH], VAEvenous air embolism, Retrospective Studies [MeSH], Middle Aged [MeSH], ASAAmerican Society of Anesthesiologists, Surgical Instruments [MeSH], Neurosurgical Procedures/methods [MeSH], PICAposterior inferior cerebellar artery, CSFcerebrospinal fluid, Intracranial Aneurysm/surgery [MeSH], Aged, Retrospective Studies
Description: Background The semi-sitting position offers advantages for surgeries in the posterior cranial fossa. However, data on its safety and effectiveness for clipping aneurysms in the posterior cerebral circulation are limited. This retrospective cohort study evaluates the safety and effectiveness of using the semi-sitting position for these surgeries. Methods We conducted a retrospective study of 17 patients with posterior cerebral circulation aneurysms who underwent surgical clipping in the semi-sitting position in the Department of Neurosurgery at Hannover Medical School over a 10-year period. Results The mean age at surgery was 62 years (range, 31 to 75). Fourteen patients were admitted with subarachnoid hemorrhage and 3 patients had incidental aneurysmas. Fifteen patients had PICA aneurysms, and two had aneurysms of the vertebral artery and the superior cerebellar artery, respectively. The median diameter of the aneurysms was 5 mm (range 3–17 mm). Intraoperative venous air embolism (VAE) occurred in 4 patients, without affecting the surgical or clinical course. VAE was associated with a mild decrease of EtCO2 levels in 3 patients and in 2 patients a decrease of blood pressure occurred which was managed effectively. Surgical procedures proceeded as planned in all instances. There were no complications secondary to VAE. Two patients died secondary to respiratory problems (not related to VAE), and one patient was lost to follow-up. Eleven of fourteen patients were partially or completely independent (Barthel index between 60 and 100) at a median follow-up duration of 13.5 months (range, 3–103 months). Conclusion The semi-sitting position is a safe and effective technique for the surgical clipping of aneurysms in the posterior cerebral circulation. The incidence of VAE is comparable to that seen in tumor surgery. However, it is crucial for the surgical and anesthesiological team to be familiar with potential complications and to react immediately in case of an occurrence of VAE.
Document Type: Article
Other literature type
Language: English
ISSN: 0942-0940
DOI: 10.1007/s00701-024-06229-1
DOI: 10.21203/rs.3.rs-4067484/v1
Access URL: https://pubmed.ncbi.nlm.nih.gov/39160268
https://repository.publisso.de/resource/frl:6505475
Rights: CC BY
Accession Number: edsair.doi.dedup.....8b6cb0ec2417365315940586c44138fe
Database: OpenAIRE
Description
Abstract:Background The semi-sitting position offers advantages for surgeries in the posterior cranial fossa. However, data on its safety and effectiveness for clipping aneurysms in the posterior cerebral circulation are limited. This retrospective cohort study evaluates the safety and effectiveness of using the semi-sitting position for these surgeries. Methods We conducted a retrospective study of 17 patients with posterior cerebral circulation aneurysms who underwent surgical clipping in the semi-sitting position in the Department of Neurosurgery at Hannover Medical School over a 10-year period. Results The mean age at surgery was 62 years (range, 31 to 75). Fourteen patients were admitted with subarachnoid hemorrhage and 3 patients had incidental aneurysmas. Fifteen patients had PICA aneurysms, and two had aneurysms of the vertebral artery and the superior cerebellar artery, respectively. The median diameter of the aneurysms was 5 mm (range 3–17 mm). Intraoperative venous air embolism (VAE) occurred in 4 patients, without affecting the surgical or clinical course. VAE was associated with a mild decrease of EtCO2 levels in 3 patients and in 2 patients a decrease of blood pressure occurred which was managed effectively. Surgical procedures proceeded as planned in all instances. There were no complications secondary to VAE. Two patients died secondary to respiratory problems (not related to VAE), and one patient was lost to follow-up. Eleven of fourteen patients were partially or completely independent (Barthel index between 60 and 100) at a median follow-up duration of 13.5 months (range, 3–103 months). Conclusion The semi-sitting position is a safe and effective technique for the surgical clipping of aneurysms in the posterior cerebral circulation. The incidence of VAE is comparable to that seen in tumor surgery. However, it is crucial for the surgical and anesthesiological team to be familiar with potential complications and to react immediately in case of an occurrence of VAE.
ISSN:09420940
DOI:10.1007/s00701-024-06229-1