- Has superseded the sitting position for neurosurgery owing to less risk of air entrainment
- It is used most often for posterior fossa surgery
Position
- Patient log rolled into lateral position
- Head is held by pins in a Mayfield frame
- In order to access the base of skull/posterior fossa, the head is tilted to towards the lower shoulders
- This curves the C-spine down from the shoulders
- Upper arm is pulled towards feet, and secured
- An axillary roll or chest pad is placed under the chest wall, below the axilla
- Patient is secured by padded supports, strapping and/or beanbag mattress
Nerve injury
- The major pressure points are:
- Upper limb: shoulder
- Torso: chest wall
- Abdomen: iliac crests
- Dependent lower limb
- Excessive gap between skull base and shoulder may put excessive tension on the brachial plexus
- Nerve pressure and other stretch injuries can occur
- Subclavian artery obstruction may cause thoracic outlet syndrome
- Eye protection is required although rigid eye shields should be avoided as they can damage the supra-orbital trigeminal nerve
- Facial and corneal oedema may occur
- Especially lingual oedema due to EJV obstruction on dependent side
- Saliva from the mouth may damage surrounding skin so appropriate skin protection or anti-sialagogues should be used