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Patient Positioning Complications Related to Neurosurgical Procedures: A Systematic Review

Patient Positioning Complications Related to Neurosurgical Procedures: A Systematic Review. Thomas Frank, Yoshua Esquenazi and Arthur L Day Vivian L. Smith Department of Neurosurgery University of Texas Medical School at Houston, USA. Introduction.

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Patient Positioning Complications Related to Neurosurgical Procedures: A Systematic Review

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  1. Patient Positioning Complications Related to Neurosurgical Procedures: A Systematic Review Thomas Frank, YoshuaEsquenaziand Arthur L Day Vivian L. Smith Department of Neurosurgery University of Texas Medical School at Houston, USA

  2. Introduction • Although rare, complications related to patient positioning during neurosurgical procedures may occur. • Long procedures are common in neurosurgery and require knowledge of potential patient positioning complications. • Acknowledging these complications, often presenting postoperatively, enables early recognition and prompt treatment.

  3. Methods • We performed a “Pubmed” literature search for English studies that reported a complication related to positioning in a neurosurgical procedure. Results are numbers of studies reporting complications were analyzed. • Search criteria: (Neurosurgery OR neurological surgery OR craniotomy OR spine surgery OR spinal surgery OR anesthesia) AND (complication OR problem) AND (position) AND (“variable”). • “Variable” referred to “(head or neck) ‘rotation’, ‘flexion’, ‘hyperflexion’, ‘hyperextension’, or ‘lateral flexion’”, body positions such as “supine”, “lawnchair”, “trendelenburg”, “lateral”, “park-bench”, “prone”, “sitting”, and various equipment.

  4. Results Overview • Complications were subject to confounding and publication bias, and some reported cases most likely were omitted by not fitting the search criteria. • Although complications were rare, each position had a characteristic complication and a few very rare outcomes. A complication can be related to multiple positions.

  5. Head/Neck Positions and Complications

  6. Supine Positions and Complications

  7. Lateral Positions and Complications

  8. Prone Positions and Complications

  9. Sitting Positions and Equipment Complications

  10. Conclusions • Neurosurgery patient positioning complications are rare, but surgeons should appreciate their possibilities in order to recognize and treat them swiftly. • Most of these complications can be prevented and permanent manifestations avoided if treated immediately. • The surgeon should appreciate the intricacies of various positions and be involved in the positioning of patients at the start of surgery.

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