• Joham Choque-Velasquez, Roberto Colasanti, Julio C Resendiz-Nieves, Kléber E Gonzáles-Echevarría, Rahul Raj, Behnam Rezai Jahromi, Felix Goehre, Ann-Christine Lindroos, and Juha Hernesniemi.
• Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: johchove@hotmail.com.
• World Neurosurg. 2018 May 1; 113: e604-e611.

BackgroundThe sitting position has lost favor among neurosurgeons partly owing to assumptions of increased complications, such as venous air embolisms and hemodynamic disturbances. Moreover, the surgeon must assume a tiring posture. We describe our protocol for the "praying position" for pineal region surgery; this variant may reduce some of the risks of the sitting position, while providing a more ergonomic surgical position.MethodsA retrospective review of 56 pineal lesions operated on using the praying position between January 2008 and October 2015 was performed. The praying position is a steeper sitting position with the upper torso and the head bent forward and downward. The patient's head is tilted about 30° making the tentorium almost horizontal, thus providing a good viewing angle. G-suit trousers or elastic bandages around the lower extremities are always used.ResultsComplete lesion removal was achieved in 52 cases; subtotal removal was achieved in 4. Venous air embolism associated with persistent hemodynamic changes was nonexistent in this series. When venous air embolism was suspected, an immediate reaction based on good teamwork was imperative. No cervical spine cord injury or peripheral nerve damage was reported. The microsurgical time was <45 minutes in most of the cases. Postoperative pneumocephalus was detected in all patients, but no case required surgical treatment.ConclusionsA protocolized praying position that includes proper teamwork management may provide a simple, fast, and safe approach for proper placement of the patient for pineal region surgery.Copyright © 2018 Elsevier Inc. All rights reserved.

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