Albeit the semi-sitting position in neurosurgery has been in use for several decades, its application remains controversial in the neurosurgical and neuro-anaesthesia communities. The imminent and most feared risk of the sitting position is air entry into the vascular system due to the negative intravascular pressure leading to potentially life-threatening air embolism with its consequences. Recent advents in neurosurgical (improvement of the operating microscope, employment of intra-operative neurophysiological monitoring) and neuro-anaesthesia care (new anaesthetics, advanced monitoring modalities) have significantly impacted the approach to these surgeries. Vigilant intra-operative observation by an experienced team and peri-operative patient management guided by institutional protocols improves the safety profile of these surgeries. This review outlines the workflow and protocols used in our institution for all cases of semi-sitting position for skull base neurosurgery.

尽管神经外科中的半坐位已经使用了几十年，但其在神经外科和神经麻醉领域的应用仍然存在争议。坐姿迫在眉睫和最令人担忧的风险是由于血管内负压导致空气进入血管系统，从而导致潜在的危及生命的空气栓塞及其后果。神经外科（手术显微镜的改进，术中神经生理监测）和神经麻醉护理（新的麻醉剂，先进的监测方式）的最新出现对这些手术的方法产生了重大影响。由经验丰富的团队进行警惕的术中观察和由机构协议指导的围手术期患者管理提高了这些手术的安全性。