Prone position versus lateral position for posterior supratentorial cerebral pathologies: a two-center retrospective comparative study

Objective: Both prone and lateral position could be used to operate supratentorial cerebral pathologies in posterior regions.This study aimed to evaluate whether one position offers superior outcomes or whether the choice should be guided by patient/pathology characteristics. Methods: Retrospective study including 58 patients with posterior supratentorial cerebral pathologies operated in either the prone (32) or lateral (26) position. Patient data (age, comorbidity, BMI) and pathology characteristics (location, volume, depth, histology) were collected. Outcomes:extent of resection, surgical complications, positioning-related complications. Statistical analyses were performed to assess whether patient or pathology factors influenced outcomes according to surgical position. Results: No significant differences were found between the two groups in terms of patient or pathology characteristics. Resection rates and complication rates were similar, none of the evaluated factors significantly influenced surgical outcomes according to the position used. Extra-axial pathologies attached to the falx appeared easier to manage in the prone position due to facilitated interhemispheric dissection, whereas the lateral position may facilitate larger craniotomies by allowing wider exposure of the hemicranium. Conclusion: Prone and lateral positioning showed comparable clinical outcomes. No specific patient/pathology characteristics clearly favored one position over the other. Positioning choice should therefore rely mainly on surgical strategy and team experience.