Khalaveh Farjad, Yildirim Mehmet-Salih, Niederle Martin, Herta Johannes, Matula Christian, Dorfer Christian, Rössler Karl
1Department of Neurosurgery, Medical University of Vienna; and.
2Department of Anesthesiology, Intensive Care Medicine and Pain Management, Medical University of Vienna, Austria.
J Neurosurg. 2024 Aug 16;142(2):529-537. doi: 10.3171/2024.4.JNS24205. Print 2025 Feb 1.
To optimize surgical positioning for posterior fossa surgery (PFS) using the semisitting position (SSP) to avoid venous air embolism (VAE) and its possible life-threatening consequences, the authors evaluated their experiences with the SSP by analyzing a large cohort of PFS patients.
A retrospective analysis of the charts of 202 consecutive PFS patients (median age 54 years, IQR 41-61 years; 121 females) with various tumor or vascular conditions who underwent surgery in an SSP between 2019 and 2022 was performed. Age, sex, weight, height, BMI, American Society of Anesthesiologists (ASA) class, histology, duration of surgery, and length of hospital stay were assessed. Transesophageal echocardiography was used pre- and intraoperatively to monitor for and assess the degree of VAE.
Altogether, VAE occurred in 30 of 202 (14.9%) patients, with clinically relevant VAE occurring in 14 of 202 (7%) patients. The grades of VAE were I, III, and IV in 16 (8%), 4 (2%), and 10 (5%) patients, respectively. Patient height (p = 0.04), ASA class (p = 0.03), and ASA class ≤ II (p = 0.02) remained the only preoperative statistically significant risk factors for intraoperative VAE, with a median height of 178 cm (IQR 172-184 cm) in patients with clinically relevant VAE compared with 170 cm (IQR 164-176 cm) in those without VAE.
In summary, the data demonstrate that SSP can be used safely for PFS when taking special care to optimize positioning in tall and lower-grade ASA patients intraoperatively.
为优化后颅窝手术（PFS）采用半坐位（SSP）时的手术体位，以避免静脉空气栓塞（VAE）及其可能危及生命的后果，作者通过分析一大群PFS患者的经验来评估他们使用SSP的情况。
对2019年至2022年间在半坐位下行手术的202例连续PFS患者（中位年龄54岁，四分位间距41 - 61岁；121例女性）的病历进行回顾性分析，这些患者患有各种肿瘤或血管疾病。评估年龄、性别、体重、身高、体重指数、美国麻醉医师协会（ASA）分级、组织学、手术时长和住院时间。术中及术前使用经食管超声心动图监测并评估VAE的程度。
202例患者中共有30例（14.9%）发生VAE，202例中有14例（7%）发生临床相关VAE。VAE分级为I级、III级和IV级的患者分别有16例（8%）、4例（2%）和10例（5%）。患者身高（p = 0.04）、ASA分级（p = 0.03）以及ASA分级≤II级（p = 0.02）仍然是术中VAE仅有的术前具有统计学意义的危险因素，发生临床相关VAE的患者中位身高为178 cm（四分位间距172 - 184 cm），而未发生VAE的患者中位身高为170 cm（四分位间距164 - 176 cm）。
总之，数据表明，在术中特别注意优化身材较高和ASA分级较低患者的体位时，SSP可安全用于PFS。
