Intracranial Operations in the Sitting Position*
During the last four years, a majority of the major intracranial operations at the Cleveland Clinic have been performed with the patient in the sitting position. This position has been found to possess many very definite advantages and also certain disadvantages. The idea of placing the patient in the erect posture for craniotomy is not new, and no claim is made for originality in any of the observations to be described. Frazier1 early appreciated the advantages of the erect posture in operations on the sensory root of the fifth nerve. In several of his communications on trigeminal neuralgia he has stated that in this position there is less bleeding, the patient requires less ether, and the field, of operation is on a level with the eyes of the operator, which facilitates exposure. For many years de Martel2 has advocated having the patient in the sitting position during intracranial operations. He has employed this method since 1911, and has found that elevation of the patient’s head decreases hemorrhage and aids respiration. On account of the greater likelihood of syncope in this position, he favors local anesthesia, which allows earlier recognition of the syncope which can be combated by lowering the patient’s head.
In 1930, I began to place the patient in the sitting position for operations on tumors of the cerebellum, with the hope of overcoming certain difficulties, such as the respiratory embarrassment, and also the occasional tendency for the cerebellum to bulge through the craniotomy opening. The cerebellar head rest. . .