Neurocirugia (English Edition)最新文献

{"title":"Efficacy of epidural infiltration in the management of pain and disability due to acute and subacute lumbosacral radiculopathy","authors":"Jose Manuel Rabanal Llevot ,&nbsp;Amaia Muñoz Alonso ,&nbsp;Alberto Taborga Echevarría ,&nbsp;Jose Angel Martínez Agueros ,&nbsp;Sergio Maldonado Vega","doi":"10.1016/j.neucie.2023.07.008","DOIUrl":"10.1016/j.neucie.2023.07.008","url":null,"abstract":"<div><h3>Background and Objective</h3><p><span>Epidural infiltrations<span> are used for treatment<span> of low back pain and sciatica. Linked to lumbar </span></span></span>radiculopathy (lumbosacral radicular syndrome). This study evaluates the efficacy of epidural infiltration by different routes to reduce pain intensity, disability and return to work.</p></div><div><h3>Methods</h3><p>Is a prospective observational study in one hundred consecutive patients sent to pain unit for severe lumbo-sacral radiculopaty. We analyze the efficacy on pain relief (Visual Analogue Scale) and funcional status at two weeks, one month, and three months after epidural injection of local anesthetics and esteroids with differents approachs (interlaminar, caudal and transforaminal).</p></div><div><h3>Results</h3><p>Ninety nine patients (46.5% men, 53.5 women) were finally enrrolled in the study. Mean age was 57.47 ± 11.1 years. The caudal approach was used in 58.6% patients, 23.2% transforaminal approach, and 18.2% interlaminar approach. A significant pain relief was found in all times studied (EAV 7.48 ± 1.5 basal; 6.2 ± 0,9 at 15 days; 6.3 ± 1.2 at one month; 6.15 ± 1.3 at 3 months, p &lt; 0.05). Transforaminal approach was superior to caudal or interlaminal. Seventy percent in time off work patients returned to work after epidural inyections.</p></div><div><h3>Conclusions</h3><p>Epidural local anesthetics with esteroids injections for lumbo-sacral radiculopathy were effective for low back pain, improved functional status and promoted return to work. Transforaminal approach is superior to others.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 64-70"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes after selective shunt during carotid endarterectomy: a propensity score matching analysis","authors":"Juliana Pereira-Macedo ,&nbsp;Luís Duarte-Gamas ,&nbsp;António Pereira-Neves ,&nbsp;José José Paulo de Andrade ,&nbsp;João Rocha-Neves","doi":"10.1016/j.neucie.2023.07.006","DOIUrl":"10.1016/j.neucie.2023.07.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><p>Carotid cross-clamping during carotid endarterectomy<span> might lead to intraoperative neurologic deficits, increasing stroke/death risk. If deficits are detected, carotid shunting has been recommended to reduce the risk of stroke. However, shunting may sustain a specific chance of embolic events and subsequently incurring harm. Current evidence is still questionable regarding its clear benefit. The aim is to determine whether a policy of selective shunt impacts the complication rate following an endarterectomy.</span></p></div><div><h3>Material and methods</h3><p><span>From January 2013 to May 2021, all patients undergoing carotid endarterectomy under regional anesthesia with intraoperative neurologic alteration were retrieved. Patients submitted to selective shunt were compared to a non-shunt group. A 1:1 </span>propensity score matching<span> (PSM) was performed. Differences between the groups and clinical outcomes were calculated, resorting to univariate analysis.</span></p></div><div><h3>Results</h3><p>Ninety-eight patients were selected, from which 23 were operated on using a shunt. After PSM, 22 non-shunt patients were compared to 22 matched shunted patients. Concerning demographics and comorbidities, both groups were comparable to pre and post-PSM, except for chronic heart failure, which was more prevalent in shunted patients (26.1%, P<!--> <!-->=<!--> <!-->0.036) in pre-PSM analysis. Regarding 30-day stroke and score Clavien–Dindo ≥2, no significant association was found (P<!--> <!-->=<!--> <!-->0.730, P<!--> <!-->=<!--> <!-->0.635 and P<!--> <!-->=<!--> <!-->0.942, P<!--> <!-->=<!--> <!-->0.472, correspondingly, for pre and post-PSM).</p></div><div><h3>Conclusions</h3><p>In this cohort, resorting to shunting did not demonstrate an advantage regarding 30-day stroke or a Clavien–Dindo ≥ 2 rates. Nevertheless, additional more extensive studies are mandatory to achieve precise results concerning the accurate utility of carotid shunting in this subset of patients under regional anesthesia.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 71-78"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10238162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures","authors":"Beatriz Dos Santos ,&nbsp;Rui Vaz ,&nbsp;Ana Cristina Braga ,&nbsp;Manuel Rito ,&nbsp;Diana Lucas ,&nbsp;Clara Chamadoira","doi":"10.1016/j.neucie.2023.09.001","DOIUrl":"10.1016/j.neucie.2023.09.001","url":null,"abstract":"<div><h3>Objectives</h3><p><span>Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) </span>in patients<span> submitted to deep brain stimulation<span> (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique.</span></span></p></div><div><h3>Methods</h3><p><span>We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, </span>antiplatelet drugs, anatomic target, and number of MER trajectories.</p></div><div><h3>Results</h3><p>There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH <em>per</em> lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension.</p></div><div><h3>Conclusions</h3><p>MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 79-86"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49685862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous CSF fistula as a manifestation of idiopathic intracranial hypertension","authors":"Samsara López Hernández ,&nbsp;Carlos Alberto Rodríguez Arias ,&nbsp;Jaime Santos Pérez ,&nbsp;Mario Martínez-Galdámez ,&nbsp;Adrián Fernández García ,&nbsp;Herbert Daniel Jiménez Zapata","doi":"10.1016/j.neucie.2023.02.002","DOIUrl":"10.1016/j.neucie.2023.02.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Spontaneous cerebrospinal fluid (CSF) fistula, of unknown origin, is a rare condition whose aetiology is increasingly related to idiopathic intracranial hypertension<span> (IIH). This study tries to raise awareness that they should not be considered as two different processes, but that fistulas<span> can be a form of debut, requiring a study and subsequent treatment. Repair techniques are described, as well as the study of HII.</span></span></p></div><div><h3>Results</h3><p><span><span>We treated 8 patients, 5 women and three men, aged between 46 and 72 years, with a diagnosis of spontaneous CSF fistula, four nasal and four otics who underwent surgical treatment. After repair, a diagnostic study was performed for IIH by MRI and Angio-MRI, presenting in all cases a </span>transverse venous sinus<span><span> stenosis. The intracranial pressure values obtained by </span>lumbar puncture showed values of 20</span></span> <!-->mm Hg or higher. All patients were diagnosed with HII. The one-year follow-up did not reveal any recurrence of the fistulas, maintaining a control of the HII.</p></div><div><h3>Conclusion</h3><p>Despite their low frequency of both cranial CSF fistula and IIH, an association of both conditions should be considered by continuing the study and surveillance of these patients after fistula closure.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 57-63"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9679251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral-type posterior fossa ependymomas in pediatric population","authors":"Pablo Miranda-Lloret,&nbsp;Estela Plaza-Ramírez,&nbsp;Juan Antonio Simal-Julián,&nbsp;Giovanni Pancucci,&nbsp;Adela Cañete,&nbsp;Alejandro Montoya-Filardi,&nbsp;Gemma Llavador","doi":"10.1016/j.neucie.2023.10.001","DOIUrl":"10.1016/j.neucie.2023.10.001","url":null,"abstract":"<div><h3>Background</h3><p>Lateral-type posterior fossa<span> ependymomas are a well-defined subtype of tumours both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series.</span></p></div><div><h3>Methods</h3><p>Among 30 cases of ependymoma operated in our paediatric department in the last ten years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study.</p></div><div><h3>Results</h3><p>Mean age of our patients was 3.75 years. 6 cases presented with hydrocephalus<span>. Mean tumour volume at diagnosis was 61 cc. A complete resection was achieved in six cases and a near-total resection in one patient. 5 patients transiently required a gastrostomy<span><span> and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. 4 cases of hydrocephalus required a ventriculoperitoneal </span>CSF shunt<span> and two were managed with a third ventriculostomy. At last follow-up 4 patients carried a normal life and two displayed a mild restriction according to Lansky´s scale.</span></span></span></p></div><div><h3>Conclusions</h3><p>The aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumours may identify risk factors that guide stratification of adjuvant therapies.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 87-94"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139513277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures","authors":"Ángel Horcajadas Almansa ,&nbsp;Luis Ley Urzaiz ,&nbsp;Roberto Garcia Leal ,&nbsp;Francisco González Llanos ,&nbsp;Mónica Lara Almunia ,&nbsp;Ruben Martinez Laez ,&nbsp;Jose M. Torres Campa ,&nbsp;Idoia Zaspe Cenoz ,&nbsp;Jesús Lafuente Baraza","doi":"10.1016/j.neucie.2023.10.003","DOIUrl":"10.1016/j.neucie.2023.10.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales.</p></div><div><h3>Methods</h3><p>The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC.</p></div><div><h3>Results</h3><p>The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined.</p></div><div><h3>Conclusions</h3><p>This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 2","pages":"Pages 95-112"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of scales for aneurysmal subarachnoid hemorrhage: Report of a reference center in Peru","authors":"Giuseppe Rojas-Panta ,&nbsp;Gian F. Reyes-Narro ,&nbsp;Carlos Toro-Huamanchumo ,&nbsp;Joham Choque-Velasquez ,&nbsp;Giancarlo Saal-Zapata","doi":"10.1016/j.neucie.2023.05.001","DOIUrl":"10.1016/j.neucie.2023.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Multiple scales have been designed to stratify the severity and predict the prognosis in the initial evaluation of patients with aneurysmal subarachnoid hemorrhage (aSAH). Our study aimed to validate the most commonly used prognostic scales for aSAH in our population: Hunt-Hess, modified Hunt-Hess, World Federation of Neurosurgical Societies (WFNS), Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH), and Barrow Aneurysm Institute (BAI) scales.</p></div><div><h3>Methods</h3><p>This study includes all aSAH cases treated at our institution between June 2019 and December 2020. We developed a retrospective cohort by reviewing medical records<span> and radiologic images performed during hospitalization. The outcome was evaluated using the modified Rankin scale (mRS). It was defined as a poor outcome (mRS 4–5) and mortality (mRS 6). The ROC curves and the area under the curve (AUC) of each of the prognostic scales were calculated to evaluate their prognostic prediction capacity.</span></p></div><div><h3>Results</h3><p>A total of 142 patients were diagnosed with aSAH. A poor outcome occurred in 52.1% of the patients, whereas mortality was 27.5%. The AUC of the scales studied was similar and no significant difference was found between them for predicting a poor outcome (<em>P</em> = .709) or mortality (<em>P</em> = .715).</p></div><div><h3>Conclusion</h3><p>We determined that the prognostic scales for aSAH had a similar predictive value for poor clinical outcomes and mortality in our institution, with no significant difference. Thus, we recommend the most simple and well-known scale used institutionally.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 1","pages":"Pages 1-5"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9638846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women in neurosurgery in Peru: current situation and representation","authors":"Martha I. Vilca-Salas ,&nbsp;Adriam M. Castilla-Encinas ,&nbsp;Marycielo Victoria Mamani-Leiva ,&nbsp;Thalia Samira Pinazo-Rios","doi":"10.1016/j.neucie.2023.07.009","DOIUrl":"10.1016/j.neucie.2023.07.009","url":null,"abstract":"<div><p>The participation of women in neurosurgery in Peru began in 1974 with the first Peruvian female neurosurgeon, who was accepted into a residency program with the condition of not getting married during her training. Nowadays, the conditions are more just, and there is greater equality of opportunities between men and women, but the numbers show that the differences have not yet been fully equalized. As evidence of this, it has been observed that only 17% of the residency positions offered in 2022 were filled by women, and there has been reduced participation of female neurosurgeons in the Peruvian Society of Neurosurgery. This article discusses the importance of tracking and promoting stories of Peruvian female neurosurgeons and calls for research in the area of women in neurosurgery in latin countries, like Peru.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 1","pages":"Pages 41-44"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41222845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type I atlanto-occipital dislocation complicated by non-communicating hydrocephalus – A case report","authors":"Maciej Kaspera,&nbsp;Marcin Niedbała,&nbsp;Igor Jastrzębski,&nbsp;Wojciech Kaspera","doi":"10.1016/j.neucie.2023.03.001","DOIUrl":"10.1016/j.neucie.2023.03.001","url":null,"abstract":"<div><p><span>Hydrocephalus<span>, an extremely rare complication of craniocervical junction injuries, is postulated to result from compression of the fourth ventricular cerebrospinal fluid<span> (CSF) outlets by fractured and displaced bone fragments, a swollen upper spinal cord or adhesions formed after a traumatic subarachnoid haemorrhage<span>. We present the case of a 21-year-old woman for whom an injury to the cervical spine complicated by a type I atlanto-occipital dislocation contributed to the development of non-communicating hydrocephalus. The hydrocephalus was probably a consequence of impaired </span></span></span></span>CSF circulation at the fourth ventricular outlets (the foramina of Luschka and Magendie), caused by post-haemorrhagic adhesions formed after severe injury to the craniocervical junction.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 1","pages":"Pages 45-50"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9337667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semisitting position for cerebello-pontine angle surgery: Analysis of complications and how to avoid it","authors":"Pelayo Hevia Rodríguez ,&nbsp;Alejandro Elúa Pinín ,&nbsp;Amaia Larrea Aseguinolaza ,&nbsp;Nicolás Samprón ,&nbsp;Mikel Armendariz Guezala ,&nbsp;Enrique Úrculo Bareño","doi":"10.1016/j.neucie.2023.07.001","DOIUrl":"10.1016/j.neucie.2023.07.001","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze the primary complications related to semisitting position in patients undergoing cerebelo-pontine angle surgery.</p></div><div><h3>Methods</h3><p><span>Retrospective data analysis from patients undergoing elective tumoral cerebelo-pontine angle surgery in a semisitting position. The incidence, severity, occurrence moment, treatment, duration, and outcomes of venous air embolism (VAE), </span>pneumocephalus<span>, postural hypotension<span>, and other complications were recorded. Neurointensive care unit (NICU), length of stay (LOS), hospital LOS, and modified Rankin scale scores were calculated six months after surgery.</span></span></p></div><div><h3>Results</h3><p>Fifty patients were operated on. Eleven (22%) presented VAE (mean duration 8<!--> <!-->±<!--> <!-->4.5<!--> <span>min): five (10%) during tumor resection, and four (8%) during dural opening. Ten (20%) were resolved by covering the surgical bed, air bubbles aspiration, jugular compression, and one (2%) tilted to a steep Trendelenburg position<span>. One (2%) had intraoperative hemodynamic<span> instability. The only variable associated with VAE was meningioma at histopathology OR</span></span></span> <!-->=<!--> <!-->4.58, <em>p</em> <!-->=<!--> <!-->0.001. NICU was higher in patients with VAE (5.5<!--> <!-->±<!--> <!-->1.06 vs. 1.9<!--> <!-->±<!--> <!-->0.20 days, <em>p</em> <!-->=<!--> <span>0.01). There were no differences in the Rankin scale. All patients presented postoperative pneumocephalus with a good level of consciousness, except one (2%) who required evacuation<span>. Seven patients (14%) showed postural hypotension, three (6%) after positioning, and one (2%) after developing a VAE; all were reversed with usual vasoactive drugs. No other position-related complications or mortality were registered in this series.</span></span></p></div><div><h3>Conclusions</h3><p>The semisitting position is a safe option with the knowledge, prevention, detection, and early solution of all the possible complications. The development of VAE rarely implies hemodynamic instability or greater disability after surgery. Postoperative pneumocephalus is very common and rarely requires evacuation. Excellent cooperation between anesthesia, nursing, neurophysiology, and neurosurgery teams is essential to manage complications.</p></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"35 1","pages":"Pages 18-29"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}