A Bibliometric Analysis of Sitting Position and Air Embolism in Neurosurgery: Top 100 Most Cited Articles

<black square> BACKGROUND: The selection of a neurosurgical sitting position (SP) regarding complication avoidance is a much-debated topic in neurosurgery and anesthesiology. In this bibliometric analysis, we examined the 100 most cited neurosurgical and anesthesiology SP articles focused on posterior fossa surgery. <black square> METHODS: The Scopus database was searched on January 25, 2025, for keywords: "neurosurgery" OR "neurological surgery" OR "anesthesiology" AND variations of "sitting" including "semisitting," "seated," "half sitting," "half-seated," "upright," and "lounging," and for "air embolism." The 100 most cited of the 2835 articles found were then reviewed in detail. <black square> RESULTS: The 100 most cited papers were published between 1964 and 2019. Venous air embolism (VAE) was the most common complication, discussed in 52 articles, with reported VAE incidences varying from 0% to 100% (median, 20%). Incidences of paradoxic air embolism ranged from 0% to 14% (median, 0%) of cases, with mortality related to VAE ranging from 0% to 0.5% (median, 0%). VAE detection methods differed throughout the years and among institutions, but how VAE was managed was similar in most reports from all institutions. Of SP reports, 61% originated from anesthesiology departments and 36% from neurosurgery departments. Nearly all reports were published in anesthesiology (51%) or neurosurgical journals (45%), with only 4% in other journal disciplines. <black square> CONCLUSIONS: The use of an SP is often debated in neurosurgery and anesthesiology. This bibliometric analysis summarizes the most cited reports to provide a guide for neurosurgeons and anesthesiologists for diagnostic evaluation, complication avoidance, and surgical management.