Gupta Priyanka, Rath Girija P, Prabhakar Hemanshu, Bithal Parmod K
Department of Neuroanesthesiology and Critical Care, All Institute of Medical Sciences (AIIMS), New Delhi, India.
Neurol India. 2018 Jan-Feb;66(1):217-222. doi: 10.4103/0028-3886.222852.
Sitting position is preferred during posterior fossa surgeries as it provides better anatomical orientation and a clear surgical field. However, its use has been declining due to its propensity to cause life-threatening complications. This study was carried out to analyze the perioperative complications and postoperative course of children who underwent neurosurgery in sitting position.
Medical records of 97 children (<18 years) who underwent neurosurgery in sitting position over a period of 12 years, were retrospectively analyzed. Data pertaining to the perioperative course such as demographics, hemodynamic changes, various complications, duration of intensive care unit (ICU) and hospital stay, and neurological status at discharge were recorded. Statistical analysis was done by chi-square and Mann-Whitney test, and a P value <0.05 was considered as significant.
The median age of these children was 12 (3-18) years. Hemodynamic instability was observed in 12 (12.3%) children. A total of 38 episodes of venous air embolism (VAE) were encountered in 21 (21.6%) children; nine experienced multiple episodes. VAE was associated with hypotension in five (23.8%) and desaturation in four (19.1%) children. Six children presented with postoperative tension pneumocephalus; three were managed with twist drill burr-hole evacuation. Brainstem handling was the most common indication (42.5%) for the requirement of elective postoperative ventilation. The duration of ICU and hospital stays were comparable among the children who experienced VAE and those who did not (P > 0.05). Neurological status at discharge was also comparable between these two groups (P = 0.83).
This study observed a lesser incidence of VAE and associated complications. Tension pneumocephalus was managed successfully without any adverse outcome. Hence, it is believed that with meticulous anesthetic and surgical techniques, sitting position can safely be practiced in children undergoing neurosurgery.
后颅窝手术中采用坐位更可取，因为它能提供更好的解剖定位和清晰的手术视野。然而，由于其易引发危及生命的并发症，其使用频率一直在下降。本研究旨在分析接受坐位神经外科手术的儿童的围手术期并发症及术后病程。
回顾性分析了97例18岁以下在12年期间接受坐位神经外科手术的儿童的病历。记录了围手术期病程的数据，如人口统计学资料、血流动力学变化、各种并发症、重症监护病房（ICU）住院时间和住院时间，以及出院时的神经状态。采用卡方检验和曼 - 惠特尼检验进行统计分析，P值<0.05被认为具有统计学意义。
这些儿童的中位年龄为12（3 - 18）岁。12例（12.3%）儿童出现血流动力学不稳定。21例（21.6%）儿童共发生38次静脉空气栓塞（VAE）；9例经历多次发作。5例（23.8%）儿童的VAE与低血压相关，4例（19.1%）与血氧饱和度下降相关。6例儿童出现术后张力性气颅；3例通过钻孔引流进行处理。脑干操作是术后需要选择性通气的最常见原因（42.5%）。发生VAE的儿童和未发生VAE的儿童在ICU住院时间和住院时间方面相当（P>0.05）。两组出院时的神经状态也相当（P = 0.83）。
本研究观察到VAE及相关并发症的发生率较低。张力性气颅得到成功处理，未出现任何不良后果。因此，相信通过细致的麻醉和手术技术，坐位可安全地应用于接受神经外科手术的儿童。
