Sitting Position for Acoustic Tumor Surgery

To the Editor .—I have read the editorial by Hitselberger and House in the FebruaryArchives(106:69,1980) concerning the use of the sitting position for acoustic tumor surgery. Hitselberger and House mention the problems of the sitting position in terms of air embolism and complications of excessive flexion of the cervical spine in patients with osteoarthritic ridging, producing spinal cord damage. Having had personal experience during the past 30 years with the use of the sitting position in the treatment of acoustic nerve tumors, an experience that obviously predates the operating microscope and even our current sophistication in the management of air embolism, I respectfully submit that Hitselberger and House have overstated their case. There is no question that small- or medium-sized acoustic nerve tumors can be removed through various positions. Large acoustic nerve tumors that splay themselves along the brainstem from the point of insertion of the lower