There are relationships that exist between neuroanesthesia, neurosurgical procedures, individual patient pathology and the positioning of a patient for said procedure. A comprehensive examination of these relationships, their association with patient morbidity/mortality and how to approach these issues in an evidence-based manner has yet to become available. Positioning related injuries have been documented as major contributors to neurosurgical/neuroanesthesiology liability.
This text examines these relationships. It provides considerations necessary to the correct positioning of a patient for a neurosurgical procedure for each individual patient and their individual pathology. In other words, this text will demonstrate how to construct the necessary surgical posture for the indicated neurosurgical procedure given the individual constraints of the patient within the environment of anesthesia and conforming to existing evidence-based practice guidelines. Sections will address physiological changes inherent in positioning in relation to anesthesia for neurosurgical procedures, assessment of patient for planned procedure, as well as considerations for managing problems associated with these relationships. Additional sections will examine the relationship between neurosurgical positioning and medical malpractice and the biomechanical science between positioning devices and neurosurgical procedures.
Neurosurgery and its patient population are in a constant state of change. Providing the necessary considerations for the neurosurgical procedure planned under the anesthesia conditions planned in the position planned, often in the absence of multicase study literary support, without incurring additional morbidity is the goal of this text.

Adam S. Arthur MD MPH FAANS FAHA FACS
Professor of Neurosurgery
University of Tennessee Health Sciences Center
Semmes-Murphey Neurological and Spine Clinic
Memphis, TN
USA

 

Kevin T. Foley, MD, FACS
Professor of Neurosurgery, Orthopaedic Surgery,& Biomedical Engineering
University of Tennessee Health Science Center
Chairman, Semmes-Murphey Clinic
Memphis, TN 
USA

 

C. Wayne Hamm CRNA, MSN, APN
Germantown, TN 
USA

 

Positioning Patients for Neurosurgical Procedures, A Historical Perspective.- Biomechanics and the Mathematics of Positioning.- Anesthesia and Patient Positioning.- Preoperative Assessment of the Patient for the Planned Position.- Organization of the Operating Room for Neurosurgical Procedures.- Overall Positioning Considerations for Intracranial Procedures.- Intracranial Procedures in the Supine, Semi-Sitting and Sitting Positions.- Intracranial Procedures in the Lateral Position.- Intracranial Procedures in the Prone Position.- Spinal Surgery Positioning Overview.- The Supine, Sitting, and Lithotomy Positions.- Spinal Procedures in the Lateral Position.- Spinal Procedures in the Prone Position.- Special Considerations in Positioning for Neurosurgical Tumors:  Spinal.- Special Considerations for Intracranial Tumors.- Special Considerations for Pediatric Positioning for Neurosurgical Procedures.- Co-Morbidities and Positioning: Morbid Obesity and Multiple Trauma.- Co-morbidities and Positioning: Pregnancy.- Post Operative Positioning in the Neurointensive Care Unit.- Differential Diagnosis, Treatment and Prognosis of Peripheral Nerve Injuries Associated with Neurosurgical Procedures.- Legal Issues in Patient Positioning.