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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2021; 8(02): 123-125
DOI: 10.1055/s-0040-1715356
Commentary

Modified Prone Positioning during Neurosurgery: Sphinx and Concorde Positions Revisited

Deep Sengupta
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Surya K. Dube
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Vanitha Rajagopalan
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
,
Girija P. Rath
1   Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Neurosurgical procedures involve various patient positions such as supine, prone, lateral, and sitting position. Prone positioning is routinely used in neurosurgical practice to obtain access to posterior neuroanatomical structures like the posterior fossa or suboccipital region.[1] Sphinx and Concorde positions are modifications of the conventional prone position that are practiced less commonly in neurosurgery, probably because it requires neuroanesthesiologists and neurosurgeons, who are familiar with these positions, and more manpower, skills, and expertise to achieve the final positioning. Since these two positions are less commonly encountered in neuroanesthesiology practice, reports about these two positions in neuroanesthesiology literature are scarce. So, we have tried to review the indications, positioning method in the operating room, advantages, and disadvantages of these modified prone positions, with further modifications added to the classical methods described earlier to further facilitate the surgical practice and perioperative care.



Publication History

Article published online:
10 August 2020

© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Rozet I, Vavilala MS. Risks and benefits of patient positioning during neurosurgical care. Anesthesiol Clin 2007; 25 (03) 631-653
    CrossrefPubMedGoogle Scholar
  • 2 Suzuki M, Sobata E, Hatanaka M, Suzuki S, Iwabuchi T, Makiguchi K. Total removal of a falcotentorial junction meningioma by biparietooccipital craniotomy in the sea lion position: a case report. Neurosurgery 1984; 15 (05) 710-714
    CrossrefPubMedGoogle Scholar
  • 3 Johnson JO, Jimenez DF, Tobias JD. Anaesthetic care during minimally invasive neurosurgical procedures in infants and children. Paediatr Anaesth 2002; 12 (06) 478-488
    CrossrefPubMedGoogle Scholar
  • 4 Francel PC, Bell A, Jane JA. Operative positioning for patients undergoing repair of craniosynostosis. Neurosurgery 1994; 35 (02) 304-306
    CrossrefPubMedGoogle Scholar
  • 5 Stricker PA, Fiadjoe JE. Anesthesia for craniofacial surgery in infancy. Anesthesiol Clin 2014; 32 (01) 215-235
    CrossrefPubMedGoogle Scholar
  • 6 Berry-Candelario J, Ridgway EB, Grondin RT, Rogers GF, Proctor MR. Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis. Neurosurg Focus 2011; 31 (02) E5
    CrossrefPubMedGoogle Scholar
  • 7 Mayorga-Buiza M, Tosca M, Rivero-Garvia MM-RJ. 9th International Update on Neuroanesthesia and Neurointensive Care EURONEURO 2016: Barcelona, Spain, April 14-16, 2016. J Neurosurg Anesthesiol 2016; 28 (02) S1-S51
    CrossrefPubMedGoogle Scholar
  • 8 Sugiyama K, Yokoyama K. Displacement of the endotracheal tube caused by change of head position in pediatric anesthesia: evaluation by fiberoptic bronchoscopy. Anesth Analg 1996; 82 (02) 251-253
    PubMedGoogle Scholar
  • 9 Kobayashi S, Sugita K, Tanaka Y, Kyoshima K. Infratentorial approach to the pineal region in the prone position: Concorde position. Technical note. J Neurosurg 1983; 58 (01) 141-143
    CrossrefPubMedGoogle Scholar
  • 10 Gulsen S, Yilmaz C, Ozdemir O, Gerilmez A, Caner H, Altinors N. Placement of three-pin head holders in the Concorde position. Turk Neurosurg 2010; 20 (02) 136-141
    PubMedGoogle Scholar
  • 11 Charbel F, Kehrli P, Pain L. [The sitting position in neurosurgery: the viewpoint of the surgeon]. Ann Fr Anesth Reanim 1998; 17 (02) 160-163
    CrossrefPubMedGoogle Scholar
  • 12 Gale T, Leslie K. Anaesthesia for neurosurgery in the sitting position. J Clin Neurosci 2004; 11 (07) 693-696
    CrossrefPubMedGoogle Scholar
  • 13 Takasuna H, Tanaka Y. The modified concorde position with an intraoperative skew head rotation: Technical note. Neurol Med Chir (Tokyo) 2015; 55 (08) 680-682
    CrossrefPubMedGoogle Scholar
  • 14 Kyoshima K. Arm-down Concorde position: a technical note. Surg Neurol 2002; 57 (06) 443-445
    CrossrefPubMedGoogle Scholar
  • 15 Kikuta KI, Miyamoto S, Kataoka H, Satow T, Yamada K, Hashimoto N. Use of the prone oblique position in surgery for posterior fossa lesions. Acta Neurochir (Wien) 2004; 146 (10) 1119-1124
    CrossrefPubMedGoogle Scholar
  • 16 Kumar A, Bhattacharjee S, Sahu BP. Kulkarni D. Brain death after Concorde positioning for supracerebellar-infratentorial approach: Unanswered questions and lessons learned. Surg Neurol Int 2012; 3: 37
    CrossrefPubMedGoogle Scholar