gms | German Medical Science

Objective: Till today there is great controversy if the improved clearance of the operation field in the semi-sitting position outweighs the surgical risks,especially in very young children. Data in the literature concerning this group of patients are sparse. The aim of this study is to present and analyze the surgical outcome and surgical complications of patients under the age of 3 years operated on intracranial lesions in the posterior fossa and pineal region in the semi-sitting position.

Method: A retrospective analysis of all patients under the age of 3 years operated at our institution between 1990 and 2013 in the semi-sitting position. Data were gathered from patients records. Neurological and clinical symptoms were assessed pre- and post-operatively. The modified Rankin score (mRs) was used to assess the clinical outcome at day of discharge.

Results: A total of 30 patients met inclusion criteria for study purposes. There were 20 boys and 10 girls, aged 6-34 months (mean 21.3). Locations of the lesion were distributed as: brain stem 2, cerebellopontine angle 5, fourth ventricle 8, cerebellar vermis 8, cerebellar hemispheres 6 and pineal region 2. Lesions were histologically classified: PNET 1, AT/RT 7, pilocytic astrocytoma WHO Grad I 4, ependymoma 1, anaplastic ependymoma 4, anaplastic astrocytoma 1, pineoblastoma 1, medulloblastoma 9, epithelial mesenchymal cyst 1, and chordoma 1. Leading symptom at presentation was increased intracranial pressure (70%). External ventricle drainages were placed in 21 patients. A venticulo-peritoneal shunt was required for 9 patients. 20 patients had neurological deficits on admission. In 22 patients postoperative neurological deficits (persisting and new) were documented. A complete resection of the lesion was observed in 15. A total of 7 (23%) complications were observed (6 transient complications and 1 permanent complication). Air embolism was detected in 2 patients, postoperative epidural hematoma 1, cerebellar infarction 1, 2 patients developed cerebrospinal fluid leakage, and 1 patient with wound healing complication. The mean mRs at discharge was 2.

Conclusions: From our data we suggest that the clearance of blood and Irrigation fluids in the operation field by gravity outweighs the surgical risks associated with the semi sitting position. Air embolisms did not affect the patients hemodynamically. Thus, infants of even very young age operated in the semi-sitting position are not prone to greater risks in comparison to other surgical positions.