SURGERY FOR POSTERIOR FOSSA TUMORS IN CHILDREN IN THE PRONE POSITION: AN ANALYSIS OF SURGICAL TECHNIQUE

Аннотация

Today, 95% of all posterior fossa surgeries in Japan are performed in the prone position, while in the United States and Europe these figures are 80% and 60%, respectively. This global trend to switch to the prone position is mainly due to the high risk of venous air embolism in the sitting position. From 1999 to 2013, the first author of this article used only the sitting position to remove posterior fossa tumors. During this period, he performed 606 surgeries. In patients with large/giant tumors (most often pilocytic astrocytomas with cysts), the surgeon often encountered the problem of a sharp recession of the cerebellum and rupture of the bridging veins, sometimes outside the surgical access zone. This situation led to either massive blood loss or venous air embolism. Material and methods. Therefore, starting in 2013, we began to selectively use the prone position for hemispheric cerebellar pilocytic astrocytomas. This initial experience allowed us to evaluate the surgical features of the operation and apply it to more complex interventions. Since mid-2016, against the background of the trend towards using keyhole approaches, we have increasingly used the prone position in surgery for PCF tumors, sometimes removing them even from the burr hole. Since the end of 2016, we have begun routinely using the prone position for various tumors of the fourth ventricle. From November 2016 to September 2017, the first author performed 113 surgeries for PCF tumors in children, of which only 4 operations were in the sitting position. Thus, in less than a year, the prone position has become the main one in surgery of all tumors of the posterior cranial fossa in our practice. In this article, we would like to share our practical considerations both on the use of the prone position and on its advantages and disadvantages that should be taken into account by a doctor who has no experience of surgery of the posterior cranial fossa in the prone position.