{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:45:14Z","timestamp":1788457514457,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background\/Objectives: Patient positioning during surgery can influence intra- and postoperative complications. Therefore, we assessed the impact of the sitting and park-bench positions on anesthetic parameters and complications in neurosurgical patients. Methods and Patients: For this retrospective study, 314 adults who underwent neurosurgical procedures for posterior fossa pathologies were divided into two groups: sitting (n = 231) and park-bench (n = 83). The following data were collected, monitored, recorded, and compared: age, sex, tumor type, surgical approach, cardiovascular and respiratory complications, and postoperative surgical complications. The association of hypotension with the position was further investigated through multivariate logistic regression models by adjusting for CO2 decrease, desaturation, and documented gas embolism. Results: The average age was significantly lower in the sitting group (55 years, interquartile range (IQR) = 43\u201363; female proportion = 59.74%) than in the park-bench group (62 years, IQR = 45\u201374; female proportion = 57.83%) (p &lt; 0.001). Cerebellopontine angle tumors were detected in 37.23% of the patients who underwent an operation in the sitting position and in 7.26% who underwent an operation in the park-bench position (p &lt; 0.001). Patients in the sitting position had significantly greater anesthetic complication (91.77% vs. 71.08%, p &lt; 0.001), hypotension (61.9% vs. 16.87%), and &gt;2 mmHg CO2 decrease (35.06% vs. 15.66%, p &lt; 0.001) incidences. Hypoxemia and death occurred more frequently in the park-bench group (8.43% vs. 1.73% and 6.03% vs. 1.3%, respectively). Conclusions: Compared with the park-bench position, the sitting position was associated with a greater specific anesthetic complication incidence and lower postoperative mortality rate, indicating a need for careful risk-benefit assessment when selecting each individual patient\u2019s surgical position.<\/jats:p>","DOI":"10.3390\/medicina60111855","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T05:21:59Z","timestamp":1731388919000},"page":"1855","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Outcomes and Complications of Posterior Fossa Surgery in Sitting Versus Park-Bench Positions"],"prefix":"10.3390","volume":"60","author":[{"given":"Oana Maria","family":"Radu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Victor Babe\u0219 Street, No. 8, 400347 Cluj-Napoca, Romania"},{"name":"Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Victor Babe\u0219 Street, No 43, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7220-8767","authenticated-orcid":false,"given":"Georgeta Magdalena","family":"Balaci","sequence":"additional","affiliation":[{"name":"Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Victor Babe\u0219 Street, No 43, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-8622","authenticated-orcid":false,"given":"Daniel Corneliu","family":"Leucu\u021ba","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Biostatistics, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Pasteur Street, No 6, 400349 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5870-1948","authenticated-orcid":false,"given":"Vlad Ioan","family":"Moisescu","sequence":"additional","affiliation":[{"name":"The Regional Institute of Gastroenterology and Hepatology Octavian Fodor, Croitorilor Street, No. 19, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Munteanu","sequence":"additional","affiliation":[{"name":"The Regional Institute of Gastroenterology and Hepatology Octavian Fodor, Croitorilor Street, No. 19, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7127-0946","authenticated-orcid":false,"given":"Ioan \u0218tefan","family":"Florian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Victor Babe\u0219 Street, No. 8, 400347 Cluj-Napoca, Romania"},{"name":"Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Victor Babe\u0219 Street, No 43, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"99","DOI":"10.17116\/neiro20228603199","article-title":"Neirokhirurgicheskie vmeshatel\u2019stva v polozhenii sidya: Real\u2019no otsenivaya riski [Sitting position in neurosurgery: Realizing the risks]","volume":"86","author":"Lubnin","year":"2022","journal-title":"Vopr. Neirokhirurgii Im. N. N. Burdenko"},{"key":"ref_2","unstructured":"Welch, M.B., Wahr, J.A., and Crowley, M. (2024, September 06). Patient Positioning for Surgery and Anesthesia in Adults. UpToDat. Available online: https:\/\/medilib.ir\/uptodate\/show\/94593."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1177\/0310057X0503300307","article-title":"Anaesthesia for neurosurgery in the sitting position: A practical approach","volume":"33","author":"Domaingue","year":"2005","journal-title":"Anaesth. Intensive Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101886","DOI":"10.1016\/j.inat.2023.101886","article-title":"Position-dependent hemodynamic changes in neurosurgery patients: A narrative review","volume":"36","author":"Emamimeybodi","year":"2024","journal-title":"Interdiscip. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1093\/bja\/73.2.247","article-title":"The sitting position in neurosurgical anaesthesia: A survey of British practice in 1991","volume":"73","author":"Elton","year":"1994","journal-title":"Br. J. Anaesth."},{"key":"ref_6","first-page":"566","article-title":"Sitting position in the neurosurgery: The results of a questionnaire sent to neurosurgeons of medical colleges","volume":"49","author":"Kida","year":"2000","journal-title":"Masui"},{"key":"ref_7","unstructured":"Macalinao, A.B., and Gavia, L.A. (2023). A Comparison of Intraoperative Occurrence of Venous Air Embolism During Posterior Fossa Surgeries in Adult Patients in Sit Up vs Horizontal Position: A Systematic Review and Meta-Analysis Study, Department of Anesthesiology and Pain Medicine, Cardinal Santos Medical Center."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"438","DOI":"10.7439\/ijbar.v7i9.3631","article-title":"A prospective study observing outcome following posterior fossa craniotomy in patients with sitting position","volume":"7","author":"Kore","year":"2016","journal-title":"Int. J. Biomed. Adv. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"867","DOI":"10.3171\/2016.8.JNS16719","article-title":"The semisitting position: Analysis of the risks surgical outcomes in a contemporary series of 425 adult patients undergoing cranial surgery","volume":"127","author":"Saladino","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.wneu.2010.09.026","article-title":"Sitting Position for Removal of Pineal Region Lesions: The Helsinki Experience","volume":"74","author":"Lindroos","year":"2010","journal-title":"World Neurosurg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.neuchi.2014.10.110","article-title":"Sitting position for pineal surgery: Some anaesthetic considerations","volume":"61","author":"Dallier","year":"2015","journal-title":"Neurochirurgie"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1093\/ajh\/hpy089","article-title":"Orthostatic Hypotension in the Hypertensive Patient","volume":"31","author":"Biaggioni","year":"2018","journal-title":"Am. J. Hypertens."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.nephro.2017.01.003","article-title":"Orthostatic hypotension: A review","volume":"13","author":"Joseph","year":"2017","journal-title":"Nephrol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/HCO.0000000000000467","article-title":"Orthostatic hypotension for the cardiologist","volume":"33","author":"Mar","year":"2018","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_15","unstructured":"Waxenbaum, J.A., Reddy, V., and Varacallo, M. (2023). Anatomy, autonomic nervous system. StatPearls, StatPearls Publishing."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1016\/j.jacc.2015.06.1084","article-title":"Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment","volume":"66","author":"Ricci","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","unstructured":"Allman, K., and Wilson, I. (2017). Oxford. Practical Guide to Anesthesia, Hipocrate. [4th ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1007\/s40140-024-00644-x","article-title":"Perioperative Ventilation in Neurosurgical Patients: Considerations and Challenges","volume":"14","author":"Iavarone","year":"2024","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00701-016-3034-7","article-title":"Venous air embolism in the sitting position in cranial neurosurgery: Incidence and severity according to the used monitoring","volume":"159","author":"Frank","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Prabhakar, H., Mahajan, C., and Kapoor, I. (2017). Manual of Neuroanesthesia. The Essentials, CRC Press.","DOI":"10.1201\/9781315154367"},{"key":"ref_21","first-page":"634","article-title":"Neurosurgery in the sitting position: Retrospective analysis of 692 adult and pediatric cases","volume":"21","author":"Dilmen","year":"2011","journal-title":"Turk. Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e335","DOI":"10.1016\/j.wneu.2022.03.125","article-title":"Occurrence and severity of venous air embolism during neurosurgical procedures: Semisitting versus supine position","volume":"163","author":"Konrad","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"291","DOI":"10.4103\/sni.sni_301_17","article-title":"Designing a pain management protocol for craniotomy: A narrative review and consideration of promis ing practices","volume":"8","author":"Vacas","year":"2017","journal-title":"Surg. Neurol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1213\/ANE.0000000000005220","article-title":"A forensic disassembly of the BIS monitor","volume":"131","author":"Connor","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"182","DOI":"10.3171\/2016.5.JNS152328","article-title":"Contemporary analysis of the intraoperative perioperative complications of neurosurgical procedures performed in the sitting position","volume":"127","author":"Himes","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jcrc.2017.08.010","article-title":"Vascular air embolism: A silent hazard to patient safety","volume":"42","author":"Brull","year":"2017","journal-title":"J. Crit. Care."},{"key":"ref_27","first-page":"836","article-title":"Clinical Significance of Pneumocephalus in Pediatric Mild Traumatic Brain Injury","volume":"39","author":"Hanalioglu","year":"2023","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e604","DOI":"10.1016\/j.wneu.2018.02.107","article-title":"Praying sitting position for pineal region surgery: An efcient variant of a classic position in neurosurgery","volume":"113","author":"Colasanti","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.4103\/0019-5049.340683","article-title":"Abstract No.: ABS0480: A retrospective study observing outcome following posterior fossa craniotomy in patients with sitting position","volume":"66","author":"Mathur","year":"2022","journal-title":"Indian J. Anaesth."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1097\/ACO.0000000000000256","article-title":"Cerebral oximetry: The standard monitor of the future?","volume":"28","author":"Moerman","year":"2015","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"105","DOI":"10.24244\/jni.v11i2.477","article-title":"Manajemen Anestesi Reseksi Tumor Cerebello-pontine Angle Vestibular Schwannoma dengan Posisi Lateral","volume":"11","author":"Suarjaya","year":"2022","journal-title":"J. Neuroanestesi Indones."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Mavarez-Martinez, A., Israelyan, L.A., Soghomonyan, S., Fiorda-Diaz, J., Sandhu, G.S., Shimansky, V.N., Ammirati, M., Palettas, M., Lubnin, A.Y., and Bergese, S.D. (2020). The Effects of Patient Positioning on the Outcome During Posterior Cranial Fossa and Pineal Region Surgery. Front. Surg., 7.","DOI":"10.3389\/fsurg.2020.00009"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E9","DOI":"10.3171\/2016.6.FOCUS16172","article-title":"Cerebral venous overdrainage: An under-recognized complication of cerebrospinal fluid diversion","volume":"41","author":"Barami","year":"2016","journal-title":"Neurosurg. Focus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1002\/bdr2.1380","article-title":"Overview on neural tube defects: From development to physical characteristics","volume":"111","author":"Avagliano","year":"2019","journal-title":"Birth Defects Res."},{"key":"ref_35","first-page":"45","article-title":"Movement of cerebrospinal fluid within craniospinal space when sitting up and lying down","volume":"10","author":"Magnaes","year":"1978","journal-title":"Surg. Neurol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/jpn.JPN_35_20","article-title":"Postoperative pneumoventricle following posterior fossa tumor surgery in sitting position: Plugging the aqueduct","volume":"15","author":"Muzumdar","year":"2020","journal-title":"J. Pediatr. Neurosci."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"231","DOI":"10.25259\/SNI_129_2024","article-title":"Communicating hydrocephalus after resection of a meningioma ventral to the foramen magnum","volume":"15","author":"Taki","year":"2024","journal-title":"Surg. Neurol. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.wneu.2017.06.165","article-title":"Modified Park Bench Position for Superior Vermian Arteriovenous Malformations and Dural Fistulas","volume":"106","author":"Griessenauer","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1093\/neuros\/nyab336","article-title":"Ventriculoperitoneal Shunt Drainage Increases with Gravity and Cerebrospinal Fluid Pressure Pulsations: Benchtop Model","volume":"89","author":"Koueik","year":"2021","journal-title":"Neurosurgery"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0750-7658(98)80067-1","article-title":"The sitting position in neurosurgery: The viewpoint of the surgeon","volume":"17","author":"Charbel","year":"1998","journal-title":"Ann. Fr. D\u2019Anesth. Reanim."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s001010050376","article-title":"Die sitzende Position bei Operationen in der Neurochirurgie. Ergebnisse einer Umfrage [The sitting position in neurosurgical operations. Results of a survey]","volume":"46","author":"Schaffranietz","year":"1997","journal-title":"Anaesthesist"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"216","DOI":"10.5455\/annalsmedres.2024.01.011","article-title":"Surgical management of foramen magnum meningiomas: Clinical insights and outcomes","volume":"31","author":"Gunerhan","year":"2024","journal-title":"Ann. Med. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"049","DOI":"10.1055\/s-0040-1712082","article-title":"Patient Positioning during Neurosurgery: A Relevant Skill for Neuroanesthesiologist in a Multidisciplinary Team Work","volume":"07","author":"Bilotta","year":"2020","journal-title":"J. Neuroanaesth. Crit. Care"},{"key":"ref_44","first-page":"54","article-title":"Air Embolism in Sitting Position during Neurosurgical Operations and It\u2019s Prevention: A Narrative Review","volume":"5","author":"Khan","year":"2019","journal-title":"Arch. Anesth. Crit. Care."},{"key":"ref_45","unstructured":"Pinto, V.L., Tadi, P., and Adeyinka, A. (2024, August 01). Increased Intracranial Pressure, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482119\/."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Haines, D.E., and Mihailoff, G.A. (2018). Chapter 8\u2014A Survey of the Cerebrovascular System. Fundamental Neuroscience for Basic and Clinical Applications, Elsevier. [5th ed.].","DOI":"10.1016\/B978-0-323-39632-5.00008-6"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"202","DOI":"10.5152\/TJAR.2015.78700","article-title":"Unanticipated Disturbance in Somatosensory Evoked Potentials in a Patient in Park-Bench Position","volume":"43","author":"Babakhani","year":"2015","journal-title":"Turk. J. Anaesthesiol. Reanim."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.wneu.2020.04.016","article-title":"Paralysis caused by spinal cord injury after posterior fossa surgery: A systematic review","volume":"139","author":"Yahanda","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1097\/ALN.0000000000002426","article-title":"Prediction Score for Postoperative Neurologic Complications after Brain Tumor Craniotomy: A Multicenter Observational Study","volume":"129","author":"Cinotti","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"106768","DOI":"10.1016\/j.clineuro.2021.106768","article-title":"Outcomes after semisitting and lateral positioning in large vestibular schwannoma surgery: A single-center comparison","volume":"207","author":"Song","year":"2021","journal-title":"Clin. Neurol. Neurosurg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1855\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:30:30Z","timestamp":1760113830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/11\/1855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,12]]},"references-count":50,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["medicina60111855"],"URL":"https:\/\/doi.org\/10.3390\/medicina60111855","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,12]]}}}