Background For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or prone positioning for resective surgery of the posterior fossa are debated, but contemporary data on direct postoperative outcome are rare. The aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in the sitting versus the nonsitting position in the direct postoperative setting.

Methods We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery exclusively in the sitting, while center 2 performed surgery only in the nonsitting position.

Results Worse functional outcome (Karnofsky performance scale) and functional deterioration were seen in the “sitting” group. We found significantly more “sitting” patients to deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated with worse outcome and more adverse events.

Conclusion Therefore, we recommend the nonsitting position for surgery of brain metastases of the posterior fossa.

The study protocol was approved by the local institutional ethics committee (TUM: 459/21 S-KH), and the study was performed in accordance to the Declaration of Helsinki. For this retrospective observational study, no individual informed consent was necessary according to the ethics committee's guidelines and regulations.

Data are available upon request.

Conceptualization was done by P.K., T.V., S.M., M.N.B., J.L., and E.S. The methodology was developed by P.K., T.V., S.M., and M.N.B. Formal analysis was done by P.K. and S.M. Data curation was done by T.V. and S.M. The original draft was prepared by P.K. and K.K. Review and editing were done by P.K., T.V., S.M., S.S., K.K., and E.S. Supervision was done by J.L. and E.S.. All the authors have read and agreed to the published version of the manuscript.

Received: 31 January 2024

Accepted: 13 June 2024

Article published online:
20 August 2024

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