{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T07:47:13Z","timestamp":1777016833242,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2022,12,11]],"date-time":"2022-12-11T00:00:00Z","timestamp":1670716800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,12,11]],"date-time":"2022-12-11T00:00:00Z","timestamp":1670716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Hochschule Hannover (MHH)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract\n<\/jats:title><jats:sec>\n                <jats:title>Objective\n<\/jats:title>\n                <jats:p>Posterior fossa or midline tumors are often associated with hydrocephalus and primary tumor removal with or without perioperative placement of an external ventricular drain (EVD) is commonly accepted as first-line treatment. Shunting prior to posterior fossa surgery (PFS) is mostly reserved for symptomatic cases or special circumstances. There are limited data regarding the anticipated risk for symptomatic pneumocephalus and the perioperative management using the semi-sitting position (SSP) in such a scenario. Here, we therefore assessed the safety of performing PFS in a consecutive series of patients over a period of 15\u00a0years to allow the elaboration of recommendations for perioperative management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>According to specific inclusion and exclusion criteria a total of 13 patients who underwent 17 operations was identified. Supratentorial pneumocephalus was evaluated with semiautomatic-volumetric segmentation. The volume of pneumocephalus was evaluated according to age and ventricular size.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Ten of the 13 patients had a programmable valve (preoperative valve setting range 6\u201314 cmH20; mean 7.5 cmH20) while 3 patients had non programmable valves. A variable amount of supratentorial air collection was evident in all patients postoperatively (range 3.2\u2013331\u00a0ml; mean 122.32\u00a0ml). Positive predictors for the volume of postoperative pneumocephalus were higher age and a preoperative Evans ratio\u2009&gt;\u20090.3. In our series, we encountered no cases of tension pneumocephalus necessitating an air replacement procedure as well as no obstruction, disconnection, infection or hardware malfunction of the shunt system.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our findings indicate that a CSF shunt in situ is not a contraindication for performing PFS in the semi-sitting position and it does not increase the pre-existing risk for postoperative tension pneumocephalus. In cases of primary shunting for hydrocephalus associated with posterior fossa tumors a programmable valve set at a medium opening pressure with a gravitational device is a valid option when PFS in the semi-sitting position is opted. In patients with an indwelling shunt diversion system special caution is indicated in order to prevent and detect overdrainage especially in not adjustable valves or shunts without antisiphon devices.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00701-022-05430-4","type":"journal-article","created":{"date-parts":[[2022,12,11]],"date-time":"2022-12-11T13:03:36Z","timestamp":1670763816000},"page":"421-427","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The semi-sitting position in patients with indwelling CSF shunts: perioperative management and avoidance of complications"],"prefix":"10.1007","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4826-8693","authenticated-orcid":false,"given":"Manolis","family":"Polemikos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Bronzlik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans E.","family":"Heissler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elvis J.","family":"Hermann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shadi","family":"Al-Afif","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Majid","family":"Esmaeilzadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim K.","family":"Krauss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,12,11]]},"reference":[{"key":"5430_CR1","doi-asserted-by":"publisher","unstructured":"Al-Afif S, Elkayekh H, Omer M, Heissler HE, Scheinichen D, Palmaers T, Nakamura M, Hermann EJ, Samii M, Krauss JK (2022) Analysis of risk factors for venous air embolism in the semisitting position and its impact on outcome in a consecutive series of 740 patients.  J Neurosurg 137:258\u2013265. https:\/\/doi.org\/10.3171\/2021.7.JNS211107","DOI":"10.3171\/2021.7.JNS211107"},{"key":"5430_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-020-01325-z","author":"P Anania","year":"2020","unstructured":"Anania P, Battaglini D, Balestrino A, D\u2019Andrea A, Prior A, Ceraudo M, Rossi DC, Zona G, Fiaschi P (2020) The role of external ventricular drainage for the management of posterior cranial fossa tumours: a systematic review. Neurosurg Rev. https:\/\/doi.org\/10.1007\/s10143-020-01325-z","journal-title":"Neurosurg Rev"},{"key":"5430_CR3","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1159\/000106394","volume":"43","author":"N Biyani","year":"2007","unstructured":"Biyani N, Silbiger A, Ben-Ari J, Constantini S (2007) Postoperative brain stem tension pneumocephalus causing transient locked-in syndrome. Pediatr Neurosurg 43:414\u2013417. https:\/\/doi.org\/10.1159\/000106394","journal-title":"Pediatr Neurosurg"},{"key":"5430_CR4","doi-asserted-by":"publisher","first-page":"e0241853","DOI":"10.1371\/journal.pone.0241853","volume":"15","author":"T Chen","year":"2020","unstructured":"Chen T, Ren Y, Wang C, Huang B, Lan Z, Liu W, Ju Y, Hui X, Zhang Y (2020) Risk factors for hydrocephalus following fourth ventricle tumor surgery: A retrospective analysis of 121 patients. PLoS One 15:e0241853. https:\/\/doi.org\/10.1371\/journal.pone.0241853","journal-title":"PLoS One"},{"key":"5430_CR5","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/bf01402388","volume":"83","author":"N Di Lorenzo","year":"1986","unstructured":"Di Lorenzo N, Caruso R, Floris R, Guerrisi V, Bozzao L, Fortuna A (1986) Pneumocephalus and tension pneumocephalus after posterior fossa surgery in the sitting position: a prospective study. Acta Neurochir (Wien) 83:112\u2013115. https:\/\/doi.org\/10.1007\/bf01402388","journal-title":"Acta Neurochir (Wien)"},{"key":"5430_CR6","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.wneu.2013.01.003","volume":"81","author":"GC Feigl","year":"2014","unstructured":"Feigl GC, Decker K, Wurms M, Krischek B, Ritz R, Unertl K, Tatagiba M (2014) Neurosurgical procedures in the semisitting position: evaluation of the risk of paradoxical venous air embolism in patients with a patent foramen ovale. World Neurosurg 81:159\u2013164. https:\/\/doi.org\/10.1016\/j.wneu.2013.01.003","journal-title":"World Neurosurg"},{"key":"5430_CR7","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1007\/s00701-017-3249-2","volume":"159","author":"M Gehlen","year":"2017","unstructured":"Gehlen M, Eklund A, Kurtcuoglu V, Malm J, Schmid Daners M (2017) Comparison of anti-siphon devices-how do they affect CSF dynamics in supine and upright posture? Acta Neurochir (Wien) 159:1389\u20131397. https:\/\/doi.org\/10.1007\/s00701-017-3249-2","journal-title":"Acta Neurochir (Wien)"},{"key":"5430_CR8","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1097\/00000542-198003000-00016","volume":"52","author":"BL Grundy","year":"1980","unstructured":"Grundy BL, Spetzler RF (1980) Subdural pneumocephalus resulting from drainage of cerebrospinal fluid during craniotomy. Anesthesiology 52:269\u2013271. https:\/\/doi.org\/10.1097\/00000542-198003000-00016","journal-title":"Anesthesiology"},{"key":"5430_CR9","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1007\/s00701-016-3034-7","volume":"159","author":"F G\u00fcnther","year":"2017","unstructured":"G\u00fcnther F, Frank P, Nakamura M, Hermann EJ, Palmaers T (2017) Venous air embolism in the sitting position in cranial neurosurgery: incidence and severity according to the used monitoring. Acta Neurochir (Wien) 159:339\u2013346. https:\/\/doi.org\/10.1007\/s00701-016-3034-7","journal-title":"Acta Neurochir (Wien)"},{"key":"5430_CR10","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1080\/17434440.2020.1837622","volume":"17","author":"P Gutowski","year":"2020","unstructured":"Gutowski P, G\u00f6lz L, Rot S, Lemcke J, Thomale UW (2020) Gravitational shunt valves in hydrocephalus to challenge the sequelae of over-drainage. Expert Rev Med Devices 17:1155\u20131168. https:\/\/doi.org\/10.1080\/17434440.2020.1837622","journal-title":"Expert Rev Med Devices"},{"key":"5430_CR11","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1007\/s00701-015-2452-2","volume":"157","author":"EJ Hermann","year":"2015","unstructured":"Hermann EJ, Petrakakis I, Polemikos M, Raab P, Cinibulak Z, Nakamura M, Krauss JK (2015) Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study. Acta Neurochir (Wien) 157:1229\u20131237. https:\/\/doi.org\/10.1007\/s00701-015-2452-2","journal-title":"Acta Neurochir (Wien)"},{"key":"5430_CR12","doi-asserted-by":"publisher","first-page":"182","DOI":"10.3171\/2016.5.Jns152328","volume":"127","author":"BT Himes","year":"2017","unstructured":"Himes BT, Mallory GW, Abcejo AS, Pasternak J, Atkinson JLD, Meyer FB, Marsh WR, Link MJ, Clarke MJ, Perkins W, Van Gompel JJ (2017) Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position. J Neurosurg 127:182\u2013188. https:\/\/doi.org\/10.3171\/2016.5.Jns152328","journal-title":"J Neurosurg"},{"key":"5430_CR13","doi-asserted-by":"publisher","first-page":"e0125710","DOI":"10.1371\/journal.pone.0125710","volume":"10","author":"B Hong","year":"2015","unstructured":"Hong B, Biertz F, Raab P, Scheinichen D, Ertl P, Grosshennig A, Nakamura M, Hermann EJ, Lang JM, Lanfermann H, Krauss JK (2015) Normobaric hyperoxia for treatment of pneumocephalus after posterior fossa surgery in the semisitting position: a prospective randomized controlled trial. PLoS One 10:e0125710. https:\/\/doi.org\/10.1371\/journal.pone.0125710","journal-title":"PLoS One"},{"key":"5430_CR14","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.clineuro.2010.10.010","volume":"113","author":"B Hong","year":"2011","unstructured":"Hong B, Nakamura M, Brandis A, Becker H, Krauss JK (2011) Spinal metastasis of papillary tumor of the pineal region. Clin Neurol Neurosurg 113:235\u2013238. https:\/\/doi.org\/10.1016\/j.clineuro.2010.10.010","journal-title":"Clin Neurol Neurosurg"},{"key":"5430_CR15","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1227\/01.Neu.0000338432.55235.D3","volume":"64","author":"S Jadik","year":"2009","unstructured":"Jadik S, Wissing H, Friedrich K, Beck J, Seifert V, Raabe A (2009) A standardized protocol for the prevention of clinically relevant venous air embolism during neurosurgical interventions in the semisitting position. Neurosurgery 64:533\u2013538. https:\/\/doi.org\/10.1227\/01.Neu.0000338432.55235.D3 (discussion 538-539)","journal-title":"Neurosurgery"},{"key":"5430_CR16","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3171\/jns.1979.50.4.0525","volume":"50","author":"LD Lunsford","year":"1979","unstructured":"Lunsford LD, Maroon JC, Sheptak PE, Albin MS (1979) Subdural tension pneumocephalus. Report of two cases. J Neurosurg 50:525\u2013527. https:\/\/doi.org\/10.3171\/jns.1979.50.4.0525","journal-title":"J Neurosurg"},{"issue":"Suppl 1","key":"5430_CR17","doi-asserted-by":"publisher","first-page":"e116","DOI":"10.1055\/s-0032-1326941","volume":"74","author":"G L\u00fctjens","year":"2013","unstructured":"L\u00fctjens G, Capelle HH, Krauss JK (2013) Akinetic mutism and parkinsonism due to subdural and intraventricular tension pneumocephalus. J Neurol Surg A Cent Eur Neurosurg 74(Suppl 1):e116-118. https:\/\/doi.org\/10.1055\/s-0032-1326941","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"5430_CR18","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.1007\/s00701-020-04504-5","volume":"162","author":"K Machetanz","year":"2020","unstructured":"Machetanz K, Leuze F, Mounts K, Trakolis L, Gugel I, Grimm F, Tatagiba M, Naros G (2020) Occurrence and management of postoperative pneumocephalus using the semi-sitting position in vestibular schwannoma surgery. Acta Neurochir (Wien) 162:2629\u20132636. https:\/\/doi.org\/10.1007\/s00701-020-04504-5","journal-title":"Acta Neurochir (Wien)"},{"key":"5430_CR19","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00701-018-3496-x","volume":"160","author":"S Marx","year":"2018","unstructured":"Marx S, Reinfelder M, Matthes M, Schroeder HWS, Baldauf J (2018) Frequency and treatment of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients. Acta Neurochir 160:1063\u20131071. https:\/\/doi.org\/10.1007\/s00701-018-3496-x","journal-title":"Acta Neurochir"},{"key":"5430_CR20","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1007\/s00381-009-0992-6","volume":"25","author":"H Prabhakar","year":"2009","unstructured":"Prabhakar H, Pal Singh G, Ali Z, Bindra A (2009) Surgery in sitting position in patient with ventriculoperitoneal shunt in situ may be hazardous! Childs Nerv Syst 25:1531\u20131532. https:\/\/doi.org\/10.1007\/s00381-009-0992-6","journal-title":"Childs Nerv Syst"},{"key":"5430_CR21","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s00701-017-3444-1","volume":"160","author":"A Sachkova","year":"2018","unstructured":"Sachkova A, Schemmerling T, Goldberg M, Solomiichuk V, Rohde V, von Eckardstein KL, Schatlo B (2018) Predictors of ventricular tension pneumocephalus after posterior fossa surgery in the sitting position. Acta Neurochir 160:525\u2013538. https:\/\/doi.org\/10.1007\/s00701-017-3444-1","journal-title":"Acta Neurochir"},{"key":"5430_CR22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1097\/ANA.0b013e3181ba99a7","volume":"22","author":"T Sloan","year":"2010","unstructured":"Sloan T (2010) The incidence, volume, absorption, and timing of supratentorial pneumocephalus during posterior fossa neurosurgery conducted in the sitting position. J Neurosurg Anesthesiol 22:59\u201366. https:\/\/doi.org\/10.1097\/ANA.0b013e3181ba99a7","journal-title":"J Neurosurg Anesthesiol"},{"key":"5430_CR23","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1227\/01.Neu.0000365272.77634.6b","volume":"66","author":"C Sprung","year":"2010","unstructured":"Sprung C, Schlosser HG, Lemcke J, Meier U, Messing-J\u00fcnger M, Trost HA, Weber F, Schul C, Rohde V, Ludwig HC, H\u00f6pfner J, Sepehrnia A, Mirzayan MJ, Krauss JK (2010) The adjustable proGAV shunt: a prospective safety and reliability multicenter study. Neurosurgery 66:465\u2013474. https:\/\/doi.org\/10.1227\/01.Neu.0000365272.77634.6b","journal-title":"Neurosurgery"},{"key":"5430_CR24","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1227\/00006123-198406000-00001","volume":"14","author":"M Standefer","year":"1984","unstructured":"Standefer M, Bay JW, Trusso R (1984) The sitting position in neurosurgery: a retrospective analysis of 488 cases. Neurosurgery 14:649\u2013658. https:\/\/doi.org\/10.1227\/00006123-198406000-00001","journal-title":"Neurosurgery"},{"key":"5430_CR25","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1227\/00006123-198302000-00005","volume":"12","author":"T Toung","year":"1983","unstructured":"Toung T, Donham RT, Lehner A, Alano J, Campbell J (1983) Tension pneumocephalus after posterior fossa craniotomy: report of four additional cases and review of postoperative pneumocephalus. Neurosurgery 12:164\u2013168. https:\/\/doi.org\/10.1227\/00006123-198302000-00005","journal-title":"Neurosurgery"},{"key":"5430_CR26","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.3171\/2017.1.Jns162489","volume":"128","author":"H T\u00fcre","year":"2018","unstructured":"T\u00fcre H, Harput MV, Bekiro\u011flu N, Keskin \u00d6, K\u00f6ner \u00d6, T\u00fcre U (2018) Effect of the degree of head elevation on the incidence and severity of venous air embolism in cranial neurosurgical procedures with patients in the semisitting position. J Neurosurg 128:1560\u20131569. https:\/\/doi.org\/10.3171\/2017.1.Jns162489","journal-title":"J Neurosurg"},{"key":"5430_CR27","doi-asserted-by":"publisher","first-page":"296","DOI":"10.3171\/2018.8.Jns181005","volume":"132","author":"SY Won","year":"2019","unstructured":"Won SY, Gessler F, Dubinski D, Eibach M, Behmanesh B, Herrmann E, Seifert V, Konczalla J, Tritt S, Senft C (2019) A novel grading system for the prediction of the need for cerebrospinal fluid drainage following posterior fossa tumor surgery. J Neurosurg 132:296\u2013305. https:\/\/doi.org\/10.3171\/2018.8.Jns181005","journal-title":"J Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05430-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-022-05430-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-022-05430-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,13]],"date-time":"2023-02-13T11:42:35Z","timestamp":1676288555000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-022-05430-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,11]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["5430"],"URL":"https:\/\/doi.org\/10.1007\/s00701-022-05430-4","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,11]]},"assertion":[{"value":"31 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 December 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2023","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Missing Open Access funding information has been added in the Funding Note.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This is a retrospective study. Ethical approval is not required by the Hannover Medical School ethics committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}