Use of the Prone Oblique Position in Surgery for Posterior Fossa Lesions

Background: The lateral suboccipital approach has been conventionally performed with the lateral, park-bench, or sitting position and the midline suboccipital approach has been performed in the prone position. We attempt to show the advantages of the prone oblique position in the surgery for posterior fossa lesions.

Methods: Twenty-two patients with posterior fossa lesions underwent surgery in the prone oblique position. The patients were fixed in the prone position while the operating table was rotated to raise the patient's shoulder. The surgeon sat beside the downward-shifted contralateral shoulder of the patient. With the lateral suboccipital approach, the neck of the patient was rotated to the side of the lesion. With the midline suboccipital approach, the neck was not rotated.

Findings: With the lateral suboccipital approach, this position spread the transverse axis of the suboccipital triangle and eliminated the interference of the patient's shoulder, providing an operative field that is wider than the lateral position or park bench position in all cases. With the midline suboccipital approach, this position enabled the surgeon to operate on lesions located in the upper half of the posterior fossa, such as fourth ventricular lesions or infratentorial lesions, without the need for a looking up posture with overhanging of the operative microscope.

Conclusion: The prone oblique position offers the operator a panoramic view of the posterior fossa.