Operative Neurosurgery

The lateral position can be used for access to the posterior parietal and occipital lobes and the lateral posterior fossa including tumors at the cerebellopontine angle and aneurysms of the basilar artery and vertebrobasilar junction. A vacuum mattress that can be molded to the patient‘s anatomic features greatly facilitates maintenance of a stable lateral position.

An axillary roll is important for preventing brachial plexus injury.

A slight head rotation to the ipsilateral side allows moving the coronal plane of both shoulders away from the surgical working space allowing the surgeon enough maneuvering freedom.

Surgeons should be aware of potential complications so as to try to avoid them and to act rapidly in case they appear. The most common are related to brachial plexus and neurovascular compression. This is why the patient’s arms should rest comfortably.

The lateral positioning used for the lateral suboccipital surgical approach is associated with various pathophysiologic complications. Strategies to avoid complications including an excessive load on the cervical vertebra and countermeasures against pressure ulcer development are needed.

In 71 patients with cerebellopontine angle lesions undergoing surgery between January 2003 and December 2010 using the lateral suboccipital approach. One patient postoperatively developed rhabdomyolysis, and another presented with transient peroneal nerve palsy on the unaffected side. Stage I and II pressure ulcers were noted in 22 and 12 patients, respectively, although neither stage III nor more severe pressure ulcers occurred. No patients experienced cervical vertebra and spinal cord impairments, brachial plexus palsy, or ulnar nerve palsy associated with rotation and flexion of the neck. Strategies to prevent positioning-related complications, associated with lateral positioning for the lateral suboccipital surgical approach, include the following: atraumatic fixation of the neck focusing on jugular venous perfusion and airway pressure, trunk rotation, and sufficient relief of weightbearing and protection of nerves including the peripheral nerves of all four extremities ¹⁾.