Anesth Analg 2002;94:474-475
© 2002 International Anesthesia Research Society
LETTERS TO THE EDITOR
Paraplegia After Sitting Position
S. Mérat, MD,
J-P. Lévecque, MD,
Y. Le Gulluche, MD,
Y. Diraison, MD,
J-M. Delmas, MD,
T. Faillot, MD, and
L. Brinquin, MD
Département d’anesthésie-réanimation, HIA du Val de Grâce, Paris, France
To the Editor: We report the case of a postsurgical paraplegia where the extent of the patient’s rachidian malformations may have played a crucial role. A 16-year-old male, with type 1 Arnold Chiari malformation, accompanied by severe scoliosis was operated on in a sitting position. No air embolism was detected during surgery. However two brief occurrences of low blood pressures at 80/40 mm Hg were detected.
Immediately after surgery, paraplegia at level D8-D10 became apparent. Somatosensory evoked potentials performed soon after the paraplegia showed an interruption of the lemniscal pathway between L1 and C7-8. The MRI scan did not reveal any medullar compression, any hematoma, or any obvious high signal.
The use of the sitting position for posterior fossa and cranio-cervical junction surgery has several advantages for the neurosurgeon and the anesthesiologist (1). However, the sitting position has also a number of possible complications, e.g., air embolism, under pressure pneumocephalus, and peripheral and central neurological complications such as tetraplegia or paraplegia (2,3). Being highly sensitive (100%) but having low specificity (17%), the monitoring of somatosensory evoked potentials (SSEP) is a way of restricting the occurrence of such complications (4). The development of monitoring of SSEP during surgery has led to a decrease in the occurrence of such complications.
References
-
Porter JM, Pidgeon C, Cunningham AJ. The sitting position in neurosurgery: a critical appraisal. Br J Anaesth 1999; 82: 117–28.[Abstract/Free Full Text]
-
Standefer M, Bay JW, Trusso R. The sitting position in neurosurgery: a retrospective analysis of 488 cases. Neurosurgery 1984; 14: 649–58.[Web of Science][Medline]
-
Matjasko J, Petrozza P, Cohen M, Steinberg P. Anaesthesia and surgery in the seated position: analysis of 554 cases. Neurosurgery 1985; 17: 695–702.[Web of Science][Medline]
-
Deinsberger W, Christophis P, Jödicke A, Heesen M, Böker DK. Somatosensory evoked potential monitory during positioning of the patient for posterior fossa surgery in the semisitting position. Neurosurgery 1998; 43: 36–42.[Medline]
|
