Abstract
Background
Because of the restricted volume of the cisternal space, proper patient positioning on the operating table is of utmost importance during surgery by retrosigmoid approaches. Three positions are commonly used: supine, with the head rotated to the side contralateral to the lesion; the semi-sitting position; and the park bench position. Each position has advantages and disadvantages, and the surgeon should choose the one best suited to the individual patient and the pathology to be treated.
Methods
We describe a modified park bench position that we call the Dormeuse position.
Conclusion
The Dormeuse position guarantees decrease in the posterior fossa pressure and allows optimal neural and vascular manipulation and control of any aspect of the cerebellopontine angle.
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Rotation of the head on the tumor side brings a more horizontal view of the long axis of the posterior petrous bone which you see as an advantage but could be debatable. The consequence of such a line of sight is the need to elevate significantly the level of the operative table specially if the surgeon needs to control what is in the depth around or even in front of the porus of the IAC ; to overcome this issue, there is a need to operate seated. Surgeons who do not seat during the surgery are limited by such constraint, which is a reason why they do not rotate the head and even more rotate the head toward the opposite side. So what you see as an advantage could be seen as not comfortable by others.
Pierre-Hugues Roche
Marseille, France
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Spena, G., Guerrini, F. & Grimod, G. A modified park bench position: the “Dormeuse” position. Acta Neurochir 161, 1823–1827 (2019). https://doi.org/10.1007/s00701-019-04013-0
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DOI: https://doi.org/10.1007/s00701-019-04013-0