Positioning Children During Neurosurgery

Positioning refers to the body position in which a patient is placed for a surgical procedure. The optimal patient position should facilitate maximum surgical access with minimum physiologic perturbations or physical injury without compromising patient safety. The fundamental considerations about the position for neurosurgery aim to (a) provide the most acceptable access to the anatomical target, ensuring the comfort of the surgeon and patient and access to the anesthesiologist and adequate access for monitoring, (b) avoid brain retraction, (c) minimize intraoperative bleeding, (d) reduce intracranial pressure (ICP), (e) ensure adequate cerebral perfusion, (f) prevent compression or traction injuries (skin dehiscence, ocular injuries, peripheral nerve injuries), and (g) increase the likelihood of a successful surgery with a good outcome. The optimum positioning of children for neurosurgery poses unique challenges due to the anatomical and physiological differences and the age-wise variations in surgical lesions. Safe and comfortable positioning of the pediatric patient is of paramount importance. Knowledge, planning, and teamwork are the major components of attentive positioning, which fulfils the aim of the surgical procedure and prevents the ensuing complications, thereby reducing perioperative morbidity. This chapter describes the special considerations for positioning pediatric patients for the commonly performed neurosurgical procedures in commonly used positions (supine, lateral, prone, sitting) and their variations, how the position is established, associated complications, and measures to mitigate these complications.