The Sitting Position in Neurosurgery: Is it Safe?

Objective: This study aimed to analyze data from patients who underwent surgery in the sitting position in our clinic and to investigate the advantages and disadvantages of this position in terms of surgery and anesthesia. By doing so, we aimed to provide a comprehensive understanding of the safety and efficacy of the sitting position in neurosurgery. Materials and Methods: Patients who underwent surgery in the sitting position in our clinic between January 2021 and December 2023 were retrospectively reviewed. Results: Of the 73 patients in this study, 31 (42.5%) were men, and 42 (57.5%) were women. The mean age of the patients was 35.27±19.66 years (min-max: 4-75 years). Patients were diagnosed with cerebellar tumors (n=34), chiari malformations (n=31), and cerebellopontine angle tumors (n=8). Nine patients developed tension pneumocephalus, and seven had postoperative complications. VAE occurred in 11 patients (15.1%). The rate of VAE was significantly higher in patients with cerebellar tumors (p<0.05). The rate of VAE was also significantly higher in patients with PFO upon TEE (p<0.05) and in those who underwent prolonged or emergency surgery (p<0.05). Conclusion: The sitting position can be used more safely in surgical operations for cerebellopontine angle tumors. However, it can be hazardous, especially in patients with cerebellar tumors, those with PFO upon TEE, and those undergoing emergency operations.