Axillary Artery Aneurysm as an Unforeseen Complication of the Park Bench Position: A Case Report

Abstract Proper patient positioning is critical in neurosurgery to optimize surgical access and minimize complications. The park bench (PB) position is frequently employed for posterior fossa procedures due to its neurosurgical advantages but carries risks of hemodynamic changes and pressure-related injuries. We report an uncommon perioperative complication in an elderly man undergoing cerebellopontine angle tumor excision in the PB position. Following a 13-h procedure, the patient developed a hematoma over the right mid-axillary region, which progressively enlarged postoperatively despite stable hemodynamic parameters and normal coagulation profiles. On the seventh postoperative day, imaging revealed a fusiform aneurysm of the right axillary artery without active bleeding or arteriovenous fistula. Conservative management was chosen due to the patient’s clinical stability and lack of distal ischemia. The hematoma subsequently resolved, and the patient was discharged without neurological deficits. This case highlights the potential for rare but significant vascular complications associated with the PB position. Prolonged mechanical compression and arm extension may have contributed to aneurysm formation or exacerbation, possibly unmasking a preexisting vascular lesion. Preventive measures, such as adequate padding, careful arm positioning, and frequent intraoperative pressure point checks, are essential to reduce the risk of neurovascular compromise. Although axillary artery aneurysms are rare, especially in the perioperative setting, clinicians should maintain a high index of suspicion in the presence of progressive hematoma. Early imaging and multidisciplinary input are crucial for timely diagnosis and safe management. This case underscores the importance of vigilant perioperative positioning and monitoring practices in complex neurosurgical procedures.