Sitting Versus Horizontal Position on Craniotomies

Study Overview
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Brief Summary
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The main objectives of this study are comparison of the incidence of intraoperative air embolism and the extent of blood loss in patients undergoing posterior cranial fossa (PCF) and pineal region (PR) surgeries in sitting and horizontal position. Additionally, the overall treatment outcome, neurological functional outcome, degree of tumor removal, clinical course in the postoperative period, and the patient satisfaction will be compared between the groups.

Detailed Description
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This was a prospective observational study to assess the effects of patient positioning during craniotomies on surgical outcomes. Patients were distributed into 2 major groups based on the surgical position: sitting and horizontal. Each group was further divided into subgroups based on the type and location of the lesion. To achieve the study goals, comparison of the 2 approaches in equivalent patient groups was performed, including comparable demographics, diagnoses, topographic location of the lesions, anesthetic approaches, and surgical experience. The operating surgeons decided patient positioning based on clinical judgment. Type of anesthesia was defined by the anesthesiologist in charge of the patient however, it was maximally standardized for both sites. All the surgeries were performed by neurosurgeons with sufficient experience of sitting craniotomies.

Official Title
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The Effects of Sitting Position on the Outcome During Surgery on Posterior Cranial Fossa and Pineal Region

Conditions
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Craniotomy, Brain Tumor

Intervention / Treatment
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* Procedure: Surgical position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients 18 - 75 years old undergoing open posterior cranial fossa and pineal region surgery and diagnosed with space-occupying or vascular lesions willing consent to participate in the study. Exclusion Criteria: Significant cardio-vascular comorbid conditions (cardiac insufficiency, recent infarction, advanced arterial hypertension) Advanced chronic respiratory comorbid conditions Uncorrected hypovolemia, anemia, hypoalbuminemia De-compensated acid base and electrolyte disorders Anticoagulated patients and patients with coagulation disorders, deep venous thrombosis (history of deep vein thrombosis or clinically established) Preoperative evidence of spinal or peripheral nerve dysfunction that may interfere with patient positioning. Cervical myelopathy Cervical spine disorders (atlanto-occipital arthritis, previous fractures etc.)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sitting Position<br>Sitting and semi-sitting | Procedure: Surgical position<br> <br> |
| Horizontal Position<br>Prone, lateral and park bench. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of intraoperative air embolism | Measured intraoperatively with transesophageal echocardiogram and/or PETCO2 levels | Time of surgery (From surgical wound incision time until wound closure) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Degree of tumor removal | Indicated by surgeon description and/or postoperative imaging | End of surgery (closure) - Postoperative evaluation by surgeon and/or postoperative imaging performed up to 48 hours after end of surgery | 
| Neurological function | Compared sensory-motor function, cranial nerve function and Glasgow scale before and after surgery. | End of surgery (closure) - Discharge from the hospital or up to 3 months after end of surgery, whichever came first. | 
| Patient satisfaction | Collected on phone script during follow-up phone call | End of surgery (closure) - 3 months after surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Posterior fossa, Pineal region