Abstract
Background: Lateral or supine positions are the traditional positions for cranial tumor resections performed with an "awake" component. These positions are used effectively for patients with tumors adjacent to speech centers or located in the superior frontal or precentral gyrus respectively.
However, these may be unsatisfactory for tumors in a close proximity to the parieto-occipital region. In this case report, we describe "awake" surgery performed on a patient in semisitting position.
Case description: A 57-year-old patient suffered second recurrence of a glioblastoma multiforme tumor with subcortical invasion of the postcentral gyrus. Due to a high risk of severe neurological deficit, it was decided to perform an awake surgery with the semisitting position providing the best exposure to the lesion and the pyramidal tract.
The pyramidal tract of the patient was mapped using motor responses to regular stimuli during which the surgeon receded the tumor. The patient was fully cooperative throughout the procedure and subjectively described the semisitting position as comfortable.
Postoperatively, the patient showed no signs of new neurological deficits. Planned re-radiation therapy was not performed.
Conclusion: This clinical case demonstrates successful use of the semisitting position in "awake" surgery and we recommend considering its use for tumors in previously challenging locations, such as the lower parietal lobules or postcentral gyrus. This position could also he used during surgeries involving visual pathways mapping.