1. POSITIONING FOR
SUPRATENTORIAL SURGERY
ADETUNMBI. B
Neurosurgery unit LUTH

2. OUTLINE
• Introduction
• Relevant anatomy
• Aims
• Principle of neurosurgery positioning
• Accessories for positioning
• Types of positioning for supratentorial lesions
• Complications
• Conclusion
• References

3. INTRODUCTION
• Positioning can be defined as the arrangement
of bodily parts or to place into an
advantageous location
• Neurosurgery procedures are usually lengthy
• First obligatory step in proper planning
• Depends on indication for surgery, approach,
patients body habitus and surgeons
preference

4. Diagram Showing the Skull

8. AIMS
• Prevent post operative complications due to
positioning
• Best access to the pathological site
• Comfort to the surgeon
• Provision of space to other team members
and efficient ergonomics

9. PRINCIPLES OF NEUROSURGICAL
POSITIONING
• Final choice of position should made known as
early as possible to the operating team
• Position chosen should ensure patients safety,
surgeons comfort, good airway access and
adequate mobility
• It should be done typically after induction
• It is sometimes necessary to disconnect
ventilator

10. contd
• Body positioned before head
• Positioning done to minimise brain retraction,
highest point to pathology site shortest
distance, craniotomy side parallel to ground
• Eye protection , lubrication and tapping.
• Adequate padding and relief of pressure
points must be ensured
• Ultimately risk/benefit ratio should considered

11. ACCESSORIES FOR POSITIONING
• Mayfield head clamp

12. Principle of use
• Must be an indication
• Avoided in aneurysm and ICH procedures, air
sinus, sutures, temporalis muscle
• Single pin usually in front while double pin
opposite.
• Usually fixed in axial plane below the equator
of the head.

13. Complications
• Heamorrhage: extracranial and intracranial
• Skin and eye avulsion
• Skull fracture
• Brain parenchymal injury
• Pin site infection

14. contd
• Horse shoe head rest

15. contd
• Doughnut head ring

16. Contd
• Others include bean bags , handrest, gel pads,
pillows

17. American Society of Anesthesiologists
Task Force on the Prevention of
Perioperative Peripheral Neuropathies

18. TYPES OF POSITIONING
• Supine
• Lateral
• Park bench
• Three quarter prone

19. SUPINE

23. LATERAL

24. LATERAL

25. PARK BENCH

26. THREE QUARTER PRONE

27. Complications of positioning
• Pressure necrosis
• Peripheral neuropathy
• Venous air embolism
• Facial oedema
• Macroglossia
• Blindness

28. CONCLUSION
• Positioning in neurosurgery cannot be
overemphasized
• Positioning is team work
• Ideal positioning gives good post operative
outcome
• A well planned surgical procedure can be
catastrophic if patient is not well positioned

29. REFERENCES
• Principles of Neurological Surgery 3rd edition
• Youmans Neurological Surgery 6th edition
• Images from wilkepeadia
• Safe positioning for neurosurgical patients :
Danielle st Arnaud
• Management of positioning in neurosurgical
patient : Lam A.M

30. THANK YOU