This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
Recently, five cases of quadriplegia following surgery for removal of an acoustic tumor have come to our attention. Although complete details of each case are not available, all of these patients had in common being operated on in the sitting position, and awakening from anesthesia with midcervical quadriplegia. To our knowledge, this complication of acoustic tumor surgery has not previously been reported. This surgical disaster apparently is the result of direct prolonged focal pressure on the cervical spinal cord. In one case, postmortem examination showed acute diffuse infarction of the midcervical cord, possibly related to a preexisting asymptomatic spondylitic bar at the level of the infarction.
There are several features of suboccipital craniectomies carried out in the sitting position that can potentiate the effects of pressure on the cervical cord. After the induction of general anesthesia and placement of the patient in the sitting position, the patient's head is
HITSELBERGER WE, HOUSE WF. A Warning Regarding the Sitting Position for Acoustic Tumor Surgery. Arch Otolaryngol. 1980;106(2):69. doi:10.1001/archotol.1980.00790260001001