Department of Neurosurgery, Hannover Medical School, Hannover, Germany.
Department of Anaesthesiology and Intensive Care, Hannover Medical School, Hannover, Germany.
Acta Neurochir (Wien). 2024 Aug 20;166(1):341. doi: 10.1007/s00701-024-06229-1.
The semi-sitting position offers advantages for surgeries in the posterior cranial fossa. However, data on its safety and effectiveness for clipping aneurysms in the posterior cerebral circulation are limited. This retrospective cohort study evaluates the safety and effectiveness of using the semi-sitting position for these surgeries.
We conducted a retrospective study of 17 patients with posterior cerebral circulation aneurysms who underwent surgical clipping in the semi-sitting position in the Department of Neurosurgery at Hannover Medical School over a 10-year period.
The mean age at surgery was 62 years (range, 31 to 75). Fourteen patients were admitted with subarachnoid hemorrhage and 3 patients had incidental aneurysmas. Fifteen patients had PICA aneurysms, and two had aneurysms of the vertebral artery and the superior cerebellar artery, respectively. The median diameter of the aneurysms was 5 mm (range 3-17 mm). Intraoperative venous air embolism (VAE) occurred in 4 patients, without affecting the surgical or clinical course. VAE was associated with a mild decrease of EtCO2 levels in 3 patients and in 2 patients a decrease of blood pressure occurred which was managed effectively. Surgical procedures proceeded as planned in all instances. There were no complications secondary to VAE. Two patients died secondary to respiratory problems (not related to VAE), and one patient was lost to follow-up. Eleven of fourteen patients were partially or completely independent (Barthel index between 60 and 100) at a median follow-up duration of 13.5 months (range, 3-103 months).
The semi-sitting position is a safe and effective technique for the surgical clipping of aneurysms in the posterior cerebral circulation. The incidence of VAE is comparable to that seen in tumor surgery. However, it is crucial for the surgical and anesthesiological team to be familiar with potential complications and to react immediately in case of an occurrence of VAE.
半坐卧位在颅后窝手术中具有优势。然而，关于其在后循环脑动脉瘤夹闭术中的安全性和有效性的数据有限。本回顾性队列研究评估了在后循环脑动脉瘤夹闭术中使用半坐卧位的安全性和有效性。
我们对在汉诺威医学院神经外科接受半坐卧位手术的 17 例后循环脑动脉瘤患者进行了回顾性研究，研究时间为 10 年。
手术时的平均年龄为 62 岁（范围 31-75 岁）。14 例患者因蛛网膜下腔出血入院，3 例患者为偶然发现的动脉瘤。15 例患者为 PICA 动脉瘤，2 例为椎动脉和小脑上动脉动脉瘤。动脉瘤的平均直径为 5 毫米（范围 3-17 毫米）。4 例患者术中发生静脉空气栓塞（VAE），但未影响手术或临床过程。VAE 与 3 例患者的 EtCO2 水平轻度下降以及 2 例患者的血压下降有关，这些情况均得到了有效处理。所有情况下手术均按计划进行。没有因 VAE 引起的并发症。2 例患者因呼吸问题（与 VAE 无关）死亡，1 例患者失访。14 例患者中有 11 例在中位随访时间为 13.5 个月（范围 3-103 个月）时部分或完全独立（Barthel 指数为 60-100）。
半坐卧位是一种安全有效的技术，可用于后循环脑动脉瘤的夹闭术。VAE 的发生率与肿瘤手术相似。然而，对于手术和麻醉团队来说，熟悉潜在的并发症并在发生 VAE 时立即做出反应至关重要。
