Semi-Sitting Position in Posterior Fossa and Pineal Region Surgery: Single-Center Experience

Aim: The semi-sitting position for intracranial surgery provides substantial surgical advantages, including improved gravitational drainage of cerebrospinal fluid and venous blood, clearer visualization, reduced intracranial pressure, and minimized cerebellar retraction. Although historically associated with complications such as venous air embolism, recent advancements in anesthetic management and intraoperative monitoring have markedly enhanced its safety profile Material and Methods: We retrospectively analyzed 17 consecutive intracranial surgeries performed in the semi-sitting position at a single center between 2019 and 2024 by a senior neurosurgeon. Patient demographics, lesion characteristics, surgical details, and outcomes were reviewed. Preoperative cardiac evaluation excluded patients with significant right-to-left intracardiac shunts. Continuous end-tidal CO₂ monitoring was used intraoperatively to detect venous air embolism. Results: Pathologies included diverse intracranial lesions in the cerebellum and pineal region. Gross total resection was achieved in 15 cases (88%). No clinically significant VAE or other intraoperative complications were detected, and no postoperative neurological deficits occurred. Our series supports the growing body of evidence that semi-sitting position is both safe and effective when applied with appropriate technique and perioperative protocols. Despite limitations related to retrospective design, small sample size, and the absence of highly sensitive monitoring tools, our findings are consistent with recent literature reporting low rates of serious complications. Conclusion: The semi-sitting position remains a viable and advantageous surgical approach for selected intracranial procedures, offering excellent surgical exposure and favorable clinical outcomes with minimal complication rates. Further prospective studies with larger cohorts and comparative controls are recommended to reinforce these findings.