• Bastianon SantiagoRaphaelRDepartment of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA., Brandon Kaye, Vivian Hagerty, Mauricio Mandel, Rocco Dabecco, Assad Ali, Michal Obrzut, Juan Botero, Hamid Borghei-Razavi, and Badih Adada.
• Department of Neurosurgery, Cleveland Clinic Florida, Weston, Florida, USA.
• World Neurosurg. 2023 Jun 27.

ObjectiveChiari I malformation results from a mismatch between the posterior fossa bones and neural components. Management usually relies on surgical treatment. Despite being the most common assumed positioning, the prone position can be challenging in high body mass index (BMI) patients (>40 kg/m2).MethodsBetween February 2020 and September 2021, 4 consecutive patients with class III obesity underwent posterior fossa decompression. The authors describe nuances of the positioning and perioperative details.ResultsNo perioperative complications were reported. These patients are at a lower risk of bleeding and increased intracranial pressure as a consequence of low intra-abdominal pressure and venous return. In this context, the semi-sitting position, with the aid of accurate monitoring for venous air embolism, seems to be an advantageous surgical position in this group of patients.ConclusionsWe present our results and technical nuances on positioning high BMI patients for posterior fossa decompression using a semi-sitting position.Copyright © 2023 Elsevier Inc. All rights reserved.

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