Semi-sitting Versus Supine Position in Endoscopic Skull Base Surgery
Semi-sitting Versus Supine Position in Endoscopic Skull Base Surgery
This study is to prospectively compare the standard supine (control group) and the
 semi-sitting position (head elevation of 30°; intervention group) in endoscopic endonasal
 pituitary surgery.
The endonasal endoscopic approach (EEA) for pituitary surgery is standardly performed with
 the patient in supine position (SP). The semi-sitting position (SSP) is routinely used for
 the traditional microscopic transsphenoidal approach and also for posterior fossa surgery.
 The SSP results in lower intracranial pressure when compared to the supine position due to
 decreased venous congestion. As a result, intraoperative bleeding may be reduced, potentially
 leading to decreased surgical morbidity and improved surgical workflow. Studies during
 endoscopic sinus surgery have shown a significant reduction of blood loss when the patient is
 placed in a reverse Trendelenburg position with a head elevation of 30°. This study is to
 prospectively compare the standard supine (control group) and the semi-sitting position (head
 elevation of 30°; intervention group) in endoscopic endonasal pituitary surgery.
Inclusion Criteria:

 -  Patients with a presumed pituitary pathologies who are suitable for endoscopic
 endonasal surgical resection

 Exclusion Criteria:

 -  Patients with known hemorrhagic or thrombophilic disorders

 -  Patients with conditions associated with high central venous pressure: congestive
 heart failure, pulmonary hypertension, chronic obstructive pulmonary disease (COPD),
 interstitial lung disease, pregnancy

 -  Patients with poor cardiopulmonary condition (unable to perform 4 metabolic
 equivalents without stopping (climb a flight of stairs))