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Background and Purpose: Head positioning is an important aspect for surgical planning in any cranial procedure. However, in neurointerventional cases, this is an afterthought due to advances in biplane imaging. We aim to present that the concept of head positioning may be applied to neurointerventional procedures to obtain optimal working projections to aide in the treatment of neurovascular pathology., Methods: The operative log of the senior author was reviewed between 2016 and 2019. Seventeen patients were identified who required readjustment of head position to allow for ideal working projection during treatment. The reports and imaging of these patients were reviewed and categorized based on repositioning adjustments applied., Results: Three specific head adjustments were performed to obtain working projections using biplanar angiography: head flexed position, head extended position, or extended-tilt positioning. All patients underwent endovascular coiling treatment for a variety of intracranial aneurysms., Conclusion: In select cases, ideal views of vascular pathology can be difficult to obtain due to limitations of biplane rotation or patient-specific anatomy. Simple maneuvers in head positioning can be done to achieve better working projections for optimized endovascular treatment., (© 2020 American Society of Neuroimaging.)

Purpose: Accuracy of panoramic radiographs is essential for distance measurements during implant planning, but it might be compromised by various factors. The aim of the present study was to evaluate the effect of vertical and horizontal head positioning on area-dependent enlargement ratios of digital panoramic radiography. Materials and Methods: The mandible of a dry skull was marked with small steel globes. The skull was moved 1 to 4 degrees in 1-degree increments to the left and right and up and down. A series of 17 panoramic radiographs was obtained with the same digital radiographic device. For the rotated skull, horizontal and vertical distances, indicated by the steel globes, were compared to the distances with the ideal positioning of the skull. The results were analyzed statistically. Results: Head positioning and angulation, anatomical site, and distance orientation influenced horizontal measurements. Enlargement ratios of horizontal distances of the right canine and first molar regions (skull rotation to the right 2 to 4 degrees) were significantly lower than those for the corresponding anatomical sites on the left side. Horizontal distance measurements of the different anatomical sites of the left and the right jaw did not differ significantly from each other when the skull was moved downward. When the skull was rotated upward, no significant differences were obtained for corresponding anatomical sites of the right and left arches. Enlargement ratios of vertical distances of different anatomical sites, as well as within the same anatomical site, were not significantly different from each other for the given skull rotations. Conclusions: Ideal head positioning for digital panoramic radiographs is mandatory to avoid improper enlargement ratios of horizontal distances, which can be important in implant dentistry. [ABSTRACT FROM AUTHOR]

Objective Several recent intraventricular hemorrhage prevention bundles include midline head positioning to prevent potential disturbances in cerebral hemodynamics. We aimed to study the impact of head position change on regional cerebral saturations SctO2 in preterm infants (< 30 weeks gestational age) during the first 3 days of life. Study Design Bilateral SctO2 was measured by near-infrared spectroscopy. The infant's head was turned sequentially to each side from midline (baseline) in 30-minute intervals while keeping the body supine. Bilateral SctO2 before and after each position change were compared using paired t-test. Results In relatively stable preterm infants (gestational age 26.5 ± 1.7 weeks, birth weight 930 ± 220 g; n = 20), bilateral SctO2 remained within normal range (71.1-75.3%) when the head was turned from midline position to either side. Conclusion Stable preterm infants tolerated brief changes in head position from midline without significant alternation in bilateral SctO2; the impact on critically ill infants needs further evaluation. [ABSTRACT FROM AUTHOR]

Considerable forces are exerted on oropharyngeal tissues during microlaryngoscopic procedures. Although it is generally accepted that positioning of the patient’s head influences the quantity of these forces and the easiness of the exposure of the anterior glottis, there is a lack of systematic studies on this topic. The aim of our study was to measure the forces occurring during microlaryngoscopy in different positions. This should result in a recommendation for a “low-pressure” position which minimises the risk of postoperative complications due to tissue trauma. Thirty consecutive patients planned for microlaryngoscopy underwent study procedures. During general anaesthesia, measurements were taken using a tension spring balance in neutral position, during extension of the cervical spine, as well as under moderate and maximum flexion. Elevation of the patient’s head thus flexing the cervical spine reduced the occurring forces significantly. Maximum elevation allowed a full exposure of the anterior commissure in all cases, whereas exposure of the anterior commissure was not possible even with maximum external counterpressure in almost 40% of cases with maximum extended cervical spine. The largest differences were observed between extension, neutral and flexion position, whereas the differences between moderate and maximum flexion were not significant. Elevation of the patient’s head with consecutive flexion of the cervical spine allows for better exposure in microlaryngoscopy and reduces significantly the pressure exerted on the oropharyngeal tissues thus minimising the risk of tissue injury. A slight modification of standard instruments can be necessary when using this “low-pressure” position. [ABSTRACT FROM AUTHOR]

Background: The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient's head positioning just before the operation is crucial to perform the procedure effectively and safely. Aim: The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI). Materials and Methods: The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured. Results: This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain. Conclusions: This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side. [ABSTRACT FROM AUTHOR]