Article
Feasibility of the semi-sitting position in children younger than 3 years of age for resection of posterior fossa tumours
Halbsitzende Lagerung bei Kindern unter 3 Jahren zur Entfernung von Tumoren der hinteren Schädelgrube
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Authors
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Elvis J. Hermann
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Gökce Hatipoglu Majernik
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Shadi Al-Afif
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
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Thomas Palmaers
- Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin, Hannover, Deutschland
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Joachim Kurt Krauss
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: The semi-sitting position for resection of posterior fossa tumors offers several surgical advantages in comparison with the prone or lateral position like easier anatomical orientation, gravity aided drainage of irrigation and clearer vision, avoidance of venous congestion by cerebellar retraction and minimization of the need for bipolar coagulation. Nevertheless, it harbors some risks, with the most dreaded beeing venous air embolism (VAE).
Methods: We analysed the datasets of children younger than 3 years of age operated in our institution over a 20-year period. Persistent foramen ovale was excluded preoperatively. Seventeen patients were intraoperatively monitored for VAE, 15 by transthoracal echography (TTE) and 2 by transoesophageal echography (TEE). Intraoperative incidents were recorded and patients course followed postoperatively with a special focus on possible complications.
Results: A total of 20 operations in 19 children were performed. There were 12 boys and 7 girls with a mean age of 31 months (range, 9 to 36 months). The histopathological diagnoses included malignant ependymoma (3), pilocytic astrocytoma (6), glioblastoma (1), medulloblastoma (6), ganglioglioma (3) and atypical rhabdoid tumor (1). No major intraoperative complications occurred. VAE was detected in 6 patients. According to the Tuebingen VAE Grading Scale, a grade 1 VAE occurred in two of them without cardiovascular or respiratory signs or symptoms. In one patient a grade 2 VAE was detected managed by intracardial aspiration of the air. In two patients a grade 4 VAE occurred with arterial hypotension with reduction of pCO2, and it was treated successfully with chatecholamin infusion and intracardial aspiration of the air. Postoperatively all children had pneumocephalus and one of them needed a permanent subduroperitoneal shunt. In two children small asymptomatic impression skull fractures due to the Mayfield pin occured.
Conclusion: The semi-sitting position in children under 3 years of age entails certain risks but it can be successfully performed taking special caution to detect and treat potential complications in an interdisciplinary teamwork.
