ArticleActa neurochirurgica2024
The safety and utility of the semi-sitting position for clipping of posterior circulation aneurysms.
Article in Acta neurochirurgica, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Safety and efficacy of the pipeline vantage flow diverter for the treatment of saccular aneurysms in the posterior cerebral circulation.The neuroradiology journal · 2026Article
- Antegrade Concorde position for leveraging the lateral supracerebellar infratentorial approach.Brain & spine · 2026Article
- Intraoperative venous air embolism during endoscopic transsphenoidal surgery: recommendations for management. Illustrative case.Journal of neurosurgery. Case lessons · 2025Article
- The microsurgical infratentorial supracerebellar approach for lesions of the pineal gland: feasibility, morbidity, and functional outcomes from a single-center experience.Neurosurgical review · 2025Article
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Abstract
backgroundThe 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.
methodsWe 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.
resultsThe 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).
conclusionThe 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.
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