Arm-down Concorde position: a technical note.

Background: When the surgeon's approach is from behind the patient's shoulder via the infratentorial supracerebellar approach in the prone position (Concorde position), the patient's shoulder nearest the surgeon occasionally interferes with the visual route and surgical manipulation. To avoid this difficulty the author developed a modified Concorde position.

Methods: In the prone position, the patient's arm at the surgeon's side hangs down over the head end of the operating table, with elbow flexion supported by an arm-holder.

Conclusions: This arm-down Concorde position provides good access for the surgeon in muscular- or broad-shouldered, short-necked, or obese patients.