Background: Use of the sitting position for neurosurgery is controversial. The main concern is the risk of venous air embolus (VAE) and its sequelae.
Methods: The paediatric neurosurgeons at our institution routinely use the sitting position for posterior fossa and pineal surgery, and a retrospective audit of the incidence of VAE from 1982 to 1998 has been performed.
Results: Venous air embolism, defined as a fall in end-tidal carbon dioxide pressure >0.4 kPa, was detected in 38 of 407 operations (9.3%). A fall in systolic arterial pressure >10% accompanied the VAE in nine out of 43 episodes (20.9%); this represents 2% of all operations. All VAE episodes responded promptly to treatment and there was no perioperative morbidity or mortality directly attributed to it.
Conclusions: This is the largest study of the incidence of VAE in children undergoing neurosurgery. Our results suggest that the sitting position can be used safely for neurosurgery in children.
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