Sitting position used to be a favored position for posterior fossa surgery. Its use has declined owing to the increased incidence of life-threatening complications. Our center continues to practice sitting craniotomy, although less frequently. This study aimed to determine the incidence of perioperative complications during sitting craniotomy.

Medical records of 206 patients who underwent posterior fossa surgery in sitting position over a 10-year period were analyzed. Data on demographics, perioperative complications, and neurological status were recorded. Statistical analysis was done using the chi-square and the Wilcoxon rank-sum tests, and a p-value of < 0.05 was considered significant.

Out of 206 eligible patients, 188 had near-complete data. A declining trend was observed in the use of the sitting position. Thirty-nine patients presented with episodes of venous air embolism (VAE) with an incidence of 20.7%. No correlation was found between cerebrospinal fluid draining procedures or previous craniotomy and the development of VAE. None of the patients reported other perioperative complications except one who developed tension pneumocephalus. Intraoperative brainstem handling was the most common reason (72%) for postoperative mechanical ventilation. At discharge, 166 (88.3%) patients had good neurological outcomes, while poor outcomes were seen in 4 and mortality in 15 (7.9%), respectively.

The incidence of perioperative complications with the sitting position was not unusually high to prevent its routine use. Moreover, the development of VAE was not associated with increased complications or patient mortality risk. The use of sitting craniotomy, while debatable, continues to be safe in expert hands.

Article published online:
18 September 2025

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