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Intracranial Procedures in the Prone Position

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Perioperative Considerations and Positioning for Neurosurgical Procedures

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Abstract

The prone position is commonly used for approaches to the posterior fossa, pineal and suboccipital regions, posterior parietal and occipital regions, and posterior approaches to the upper cervical spine. Because of the relatively high complication rate and disadvantages of the sitting and semi-sitting positions, especially the risk of venous air embolism, the prone position and its modifications (Concorde and arm-down Concorde) are becoming more important for everyday surgical practice. In this chapter, we discuss the physiology of the prone position and its general and specific considerations for positioning the patient for lesions of the posterior fossa and pineal region, as well as complications.

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References

  1. Rozet I, Vavilala MS. Risks and benefits of patient positioning during neurosurgical care. Anesthesiol Clin. 2007;25(3):631–53. x.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Backofen JE, Schauble JF. Hemodynamic changes with prone position during general anaesthesia. Anesth Analg. 1985;64:194.

    Google Scholar 

  3. Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth. 2008;100(2):165–83.

    Article  CAS  PubMed  Google Scholar 

  4. Sudheer PS, Logan SW, Ateleanu B, Hall JE. Haemodynamic effects of the prone position: a comparison of propofol total intravenous and inhalation anaesthesia. Anaesthesia. 2006;61(2):138–41.

    Article  CAS  PubMed  Google Scholar 

  5. Rolighed Larsen JK, Haure P, Cold GE. Reverse Trendelenburg position reduces intracranial pressure during craniotomy. J Neurosurg Anesthesiol. 2002;14(1):16–21.

    Article  PubMed  Google Scholar 

  6. Reinprecht A, Greher M, Wolfsberger S, Dietrich W, Illievich UM, Gruber A. Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med. 2003;31(6):1831–8.

    Article  PubMed  Google Scholar 

  7. Rasmussen M, Cold GE. Subdural intracranial pressure, cerebral haemodynamics, dural tension and degree of swelling after opening of dura in patients with infratentorial tumors. In: Cold GE, Juul N, editors. Monitoring of cerebral and spinal haemodynamics during neurosurgery. Berlin: Springer; 2008.

    Google Scholar 

  8. Rosin D, Rosenthal RJ. Adverse hemodynamic effects of intraabdominal pressure—is it all in the head? Int J Surg Investig. 2001;2(5):335–45.

    CAS  PubMed  Google Scholar 

  9. Kamine TH, Papavassiliou E, Schneider BE. Effect of abdominal insufflation for laparoscopy on intracranial pressure. JAMA Surg. 2014;149(4):380–2.

    Article  PubMed  Google Scholar 

  10. Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, et al. The American-European Consensus Conference on ARDS, part 2. Ventilatory, pharmacologic, supportive therapy, study design strategies and issues related to recovery and remodeling. Intensive Care Med. 1998;24(4):378–98.

    Article  CAS  PubMed  Google Scholar 

  11. Beuret P, Carton MJ, Nourdine K, Kaaki M, Tramoni G, Ducreux JC. Prone position as prevention of lung injury in comatose patients: a prospective, randomized, controlled study. Intensive Care Med. 2002;28(5):564–9.

    Article  PubMed  Google Scholar 

  12. Georgiadis D, Schwarz S, Kollmar R, Baumgartner RW, Schwab S. Influence of inspiration:expiration ratio on intracranial and cerebral perfusion pressure in acute stroke patients. Intensive Care Med. 2002;28(8):1089–93.

    Article  PubMed  Google Scholar 

  13. Robba C, Bragazzi NL, Bertuccio A, Cardim D, Donnelly J, Sekhon M, et al. Effects of prone position and positive end-expiratory pressure on noninvasive estimators of ICP: a pilot study. J Neurosurg Anesthesiol. 2017;29(3):243–50.

    Article  PubMed  Google Scholar 

  14. Young N, Rhodes JK, Mascia L, Andrews PJ. Ventilatory strategies for patients with acute brain injury. Curr Opin Crit Care. 2010;16(1):45–52.

    Article  PubMed  Google Scholar 

  15. Winn HR. Positioning for cranial surgery. In: Webster Crowley R, Dumont AS, Sean McKisic M, Jane Sr JA, editors. Youmans neurological surgery, 4-Volume Set: Expert Consult - Online and Print, (Winn, Neurological Surgery). 6th ed. Philadelphia: Saunders; 2011.

    Google Scholar 

  16. Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders’—complications in neurosurgery: a review of the literature and recommendations for its use. Neurochirurgie. 2016;62(6):289–94.

    Article  PubMed  Google Scholar 

  17. Dybec RB, Kneedler JA, Pfiester JI. Basic principles of patient positioning (Online Continuing Education Activity) Pfiedler Enterprises; 2013. www.pfiedler.com/1079/.

  18. Lopez-Olivo MA, Andrabi TR, Palla SL, Suarez-Almazor ME. Cervical spine radiographs in patients with rheumatoid arthritis undergoing anesthesia. J Clin Rheumatol. 2012;18(2):61–6.

    Article  PubMed  Google Scholar 

  19. Krause ML, Matteson EL. Perioperative management of the patient with rheumatoid arthritis. World J Orthop. 2014;5(3):283–91.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kwee MM, Ho YH, Rozen WM. The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg. 2015;100(2):292–303.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mobley SR, Miller BT, Astor FC, Fine B, Halliday NJ. Prone positioning for head and neck reconstructive surgery. Head Neck. 2007;29(11):1041–5.

    Article  PubMed  Google Scholar 

  22. Arnautovic KI, Muzevic D, Splavski B, Boop FA. Association of increased body mass index with Chiari malformation Type I and syrinx formation in adults. J Neurosurg. 2013;119(4):1058–67.

    Article  PubMed  Google Scholar 

  23. Kobayashi S, Sugita K, Tanaka Y, Kyoshima K. Infratentorial approach to the pineal region in the prone position: concorde position. Technical note. J Neurosurg. 1983;58(1):141–3.

    Article  CAS  PubMed  Google Scholar 

  24. Takasuna H, Tanaka Y. The modified concorde position with an intraoperative skew head rotation: technical note. Neurol Med Chir (Tokyo). 2015;55(8):680–2.

    Article  Google Scholar 

  25. Kyoshima K. Arm-down concorde position: a technical note. Surg Neurol. 2002;57(6):443–5. discussion 5–6.

    Article  PubMed  Google Scholar 

  26. Broadway SJ, Arnautovic KI, Zhang Y. Xanthoma of the occipital bone and with preserved inner and outer bone cortex: case report. J Neurol Surg Rep. 2013;74(1):29–32.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lakičević G, Arnautović K, Mužević D, Chesney T. Cerebellar glioblastoma multiforme presenting as hypertensive cerebellar hemorrhage: case report. J Neurol Surg Rep. 2014;75(1):e117–21.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pait TG, Al-Mefty O, Boop FA, Arnautovic KI, Rahman S, Ceola W. Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results. J Neurosurg. 1999;90(1 Suppl):1–7.

    CAS  PubMed  Google Scholar 

  29. Mooij JJA. How to perform posterior fossa approaches. In: Sindou M, editor. Practical handbook of neurosurgery from leading neurosurgeons. New York: Springer; 2009.

    Google Scholar 

  30. Sekhar L, Oliveira E. Cranial microsurgery: approaches and techniques. Stuttgart: Thieme; 1998.

    Google Scholar 

  31. Samson D, White JA, Welch BG. Posterior fossa Arteriovenous malformations. In: Macdonald RL, editor. Neurosurgical operative atlas vascular neurosurgery. Stuttgart: Thieme; 2008.

    Google Scholar 

  32. Vannemreddy P, Ezer H, Nanda A. Posterior Interhemispheric approach to pineal region and brainstem. In: Nanda A, editor. Principles of posterior fossa surgery. Stuttgart: Thieme; 2012.

    Google Scholar 

  33. Chui J, Craen RA. An update on the prone position: continuing professional development. Can J Anaesth. 2016;63(6):737–67.

    Article  PubMed  Google Scholar 

  34. Prabhakar H, Bithal PK, Ghosh I, Dash HH. Pneumorrhachis presenting as quadriplegia following surgery in the prone position. Br J Anaesth. 2006;97(6):901–3.

    Article  CAS  PubMed  Google Scholar 

  35. Rau CS, Liang CL, Lui CC, Lee TC, Lu K. Quadriplegia in a patient who underwent posterior fossa surgery in the prone position. Case report. J Neurosurg. 2002;96(1 Suppl):101–3.

    PubMed  Google Scholar 

  36. Ziser A, Friedhoff RJ, Rose SH. Prone position: visceral hypoperfusion and rhabdomyolysis. Anesth Analg. 1996;82(2):412–5.

    CAS  PubMed  Google Scholar 

  37. Luostarinen T, Lindroos AC, Niiya T, Silvasti-Lundell M, Schramko A, Hernesniemi J, et al. Prone versus sitting position in neurosurgery—differences in patients’ hemodynamic management. World Neurosurg. 2016;97:261–6.

    Article  PubMed  Google Scholar 

  38. Matjasko J, Petrozza P, Cohen M, Steinberg P. Anesthesia and surgery in the seated position: analysis of 554 cases. Neurosurgery. 1985;17(5):695–702.

    Article  CAS  PubMed  Google Scholar 

  39. Domaingue CM. Anaesthesia for neurosurgery in the sitting position: a practical approach. Anaesth Intensive Care. 2005;33(3):323–31.

    CAS  PubMed  Google Scholar 

  40. Arnautović KI, al-Mefty O, Pait TG, Krisht AF, Husain MM. The suboccipital cavernous sinus. J Neurosurg. 1997;86(2):252–62.

    Article  PubMed  Google Scholar 

  41. Hübler M, Petrasch F. Intraoperative kinking of polyvinyl endotracheal tubes. Anesth Analg. 2006;103(6):1601–2.

    Article  PubMed  Google Scholar 

  42. Bharti N, Bala I. Kinking of endotracheal tube during posterior fossa surgery. Indian J Anaesth. 2010;54(2):172–3.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hans P, Demoitié J, Collignon L, Bex V, Bonhomme V. Acute bilateral submandibular swelling following surgery in prone position. Eur J Anaesthesiol. 2006;23(1):83–4.

    Article  CAS  PubMed  Google Scholar 

  44. Tsung YC, Wu CT, Hsu CH, Yeh CC, Lin SL, Wong CS. Macroglossia after posterior fossa surgery in the prone position--a case report. Acta Anaesthesiol Taiwanica. 2006;44(1):43–6.

    Google Scholar 

  45. Sinha A, Agarwal A, Gaur A, Pandey CK. Oropharyngeal swelling and macroglossia after cervical spine surgery in the prone position. J Neurosurg Anesthesiol. 2001;13(3):237–9.

    Article  CAS  PubMed  Google Scholar 

  46. Pivalizza EG, Katz J, Singh S, Liu W, McGraw-Wall BL. Massive macroglossia after posterior fossa surgery in the prone position. J Neurosurg Anesthesiol. 1998;10(1):34–6.

    Article  CAS  PubMed  Google Scholar 

  47. Ogiwara T, Goto T, Aoyama T, Nagm A, Yamamoto Y, Hongo K. Bony surface registration of navigation system in the lateral or prone position: technical note. Acta Neurochir. 2015;157(11):2017–22.

    Article  PubMed  Google Scholar 

  48. Nimsky C, Kuhnt D, Ganslandt O, Buchfelder M. Multimodal navigation integrated with imaging. Acta Neurochir Suppl. 2011;109:207–14.

    Article  PubMed  Google Scholar 

  49. Hermann EJ, Petrakakis I, Polemikos M, Raab P, Cinibulak Z, Nakamura M, et al. Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study. Acta Neurochir. 2015;157(7):1229–37.

    Article  PubMed  Google Scholar 

  50. Lee L, Cho S, Nguyen V, Rattlif J, Park J, Lopez J. Critical intraoperative neurophysiologic monitoring (IONM) changes associated with patients positioning maneuvrs. Neurology. 2014;82(10 Supplement):P6.336.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Philipps University Marburg, Marburg, Germany

    Mirza Pojskic

  2. Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee, Memphis, TN, USA

    Mirza Pojskic & Kenan I. Arnautovic

Authors
  1. Mirza Pojskic
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  2. Kenan I. Arnautovic
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Editor information

Editors and Affiliations

  1. Semmes-Murphey Neurologic and Spine Clinic, Memphis, Tennessee, USA

    Adam Arthur

  2. Semmes-Murphey Neurologic and Spine Clinic, Memphis, Tennessee, USA

    Kevin Foley

  3. Medical Anesthesia Group, Germantown, Tennessee, USA

    C. Wayne Hamm

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Pojskic, M., Arnautovic, K.I. (2018). Intracranial Procedures in the Prone Position. In: Arthur, A., Foley, K., Hamm, C. (eds) Perioperative Considerations and Positioning for Neurosurgical Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-72679-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-72679-3_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-72678-6

  • Online ISBN: 978-3-319-72679-3

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