Use of the sitting position for pineal tumour surgery in a five-year-old child

The sitting position provides almost ideal access to several areas within the cranium. The high risk of air embolism has led to decreased use of the sitting position. However, improved identification of patients at risk of paradoxical embolism may allow a more calculated, safer use thereof. Despite an improved understanding of the risks, many neurosurgical centres seldom use this position, and the occasional use of a complex patient position can then create additional challenges. This case report of a child requiring pineal surgery in the sitting position includes a review of the use of this position in children, and highlights the current emphasis on assessing the risk of paradoxical embolism before proceeding to the use of such a position.