Article
Semi-sitting position in children younger than 3 years of age for resection of posterior fossa midline tumors
Search Medline for
Authors
-
Elvis Josef Hermann
- Medizinische Hochschule Hannover, Neurochirurgische Klinik, Hannover, Deutschland
-
Shadi Al-Afif
- Medizinische Hochschule Hannover, Klinik für Neurochirurgie, Hannover, Deutschland
-
Thomas Palmaers
- Medizinische Hochschule Hannover, Klinik für Anästhesiologie und Intensivmedizin, Hannover, Deutschland
-
Joachim K. Krauss
- Medizinische Hochschule Hannover, Neurochirurgische Klinik, Klinik für Neurochirurgie, Hannover, Deutschland
| Published: | June 9, 2017 |
|---|
Outline
Text
Objective: The semi-sitting position is one of the preferred positions for resection of posterior fossa midline tumors. Nevertheless, it harbors some risks, with the most dreaded beeing air embolism. In small children another additional risk is rigid head fixation in the Mayfield clamp. Here we report about our experience with the semi-sitting position in children younger than 3 years of age.
Methods: Seven children younger than 3 years of age were operated in the semi-sitting position (mean age: 20 months; range between 3 and 36 months). Persistent foramen ovale was excluded preoperatively. Intraoperative incidents were recorded and patients course followed postoperatively with a special focus on possible complications.
Results: The histopathological diagnoses included ependymoma (n=2), pilocytic astrocytoma (n=2), glioblastoma (n=1), medulloblastoma (n=1) and ganglioglioma (n=1). External ventricular drains were inserted in 5 of 6 children who presented with hydrocephalus preoperatively. No major intraoperative complications occurred. Air embolism was detected in 3 patients during surgery. In two of them, the air embolism was recorded in TEE without cardiovascular or respiratory signs or symptoms. In one patient arterial hypotension with reduction of pCO2 occurred and it was treated successfully with chatacholamin infusion and suction of air embolism via a central venous catheter without postoperative complications due to the embolism. Postoperatively all children showed pneumocephalus and one of them developed a subdural hygroma and was treated by a permanent subduroperitoneal shunt. In two children small asymptomatic impression skull fractures at the side of a Mayfield pin were evident in the postoperative scans. Revision surgery was necessary in one child with a suboccipital CSF fistula. One child needed permanent CSF diversion because of persisting hydrocephalus (ventriculoperitoneal shunt).
Conclusion: The semi-sitting position for tumor resection of the posterior fossa in children under 3 years of age entails certain risks, however, it can be successfully performed taking special caution to detect and treat potential complications in an interdisciplinary teamwork with specialized neuroanaesthesiologists.
