Risk and benefits of patient positioning during neurosurgical procedures

Patient positioning in surgical procedures has serious implications on clinical outcome. While surgical approach and exposure are considered by surgeons, frequently, the importance of properly positioning the patient, accounting for the clinical situation and co-morbidities, is overlooked. This is particularly true in many neurosurgical procedures, which require prolonged anesthesia and immobilization. Traditionally, it is the anesthesiologists’ responsibility to look after the well being of the patient, and maintain an adequate physiological environment, promoting full recovery. In this review, we analyze the different positions common in neurosurgery considering and balancing between surgical exposure, hemodynamic implications, patient comfort and neurological outcomes. The latter should be given particular attention, as it might be difficult to differentiate between neurological deficits which are a result of the patient’s position, and those that are part of the underlying condition or surgical complication. Some positions interfere with standard monitoring or necessitate temporary interruption of or ventilation and continuous IV treatment. These as should be taken into account as well, reducing the interruption to the minimum. Finally, several complications are associated with specific positions and the approach to these complications is discussed. The review has been divided into two separate parts. In the previous issue of the journal we discussed the problems, related to head, neck and body positioning including supine and lateral position. Here we offer you the second part of the review, discussing benefits and problems related to prone and sitting position and specific complications including venous air embolism, blindness in prone position and pneumocephalus.