Chiari Malformation Type 1 and Semi-Sitting Position-A Suitable Alternative for Patients with High BMI.

Document Type

Article

Publication Date

9-2023

Publication Title

World Neurosurgery

Keywords

Body mass index, Chiari malformation type 1, Morbid obesity, Posterior fossa decompression, Semi-sitting position, Surgical positioning

ISSN

1878-8769

Volume

117

First Page

e433

Last Page

e439

Abstract

OBJECTIVE: Chiari I malformation results from a mismatch between the posterior fossa bones and neural components. Management usually relies on surgical treatment. Despite being the most common assumed positioning, the prone position can be challenging in high body mass index (BMI) patients (>40 kg/m

METHODS: Between February 2020 and September 2021, 4 consecutive patients with class III obesity underwent posterior fossa decompression. The authors describe nuances of the positioning and perioperative details.

RESULTS: No perioperative complications were reported. These patients are at a lower risk of bleeding and increased intracranial pressure as a consequence of low intra-abdominal pressure and venous return. In this context, the semi-sitting position, with the aid of accurate monitoring for venous air embolism, seems to be an advantageous surgical position in this group of patients.

CONCLUSIONS: We present our results and technical nuances on positioning high BMI patients for posterior fossa decompression using a semi-sitting position.

DOI

10.1016/j.wneu.2023.06.071

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