Mealey Lecturer Urges a Once-Popular Technique Deserves a Comeback

In an engaging address that shared both personal and surgical history, Paul Camarata, MD, presented the 8th Annual Mealey Lecture in a discussion titled, “The Evanescent Semi-Sitting Position in Tumor Surgery—Time for Its Revival?” on May 23 at Indiana University’s Goodman Hall Auditorium.Camarata is professor and chairman of the Department of Neurosurgery at the University of Kansas in Kansas City. The annual lecture honors John Mealy, Jr., MD, a retired Professor Emeritus of Neurosurgery in the Department of Neurological Surgery.

“Dr. Mealey is an inspiration to me in a number of ways,” Camarata said prior to his lecture. “His pursuit of a cure for brain cancer through his involvement in the Brain Tumor Cooperative Group for over 40 years is heroic and speaks to his compassionate care as a healer.”

Camarata recalled meeting Dr. Mealey in 1984 while visiting the National Institute of Neurological Disorders and Stroke as a medical student.

“He was there with the Brain Tumor Cooperative Group,” he said. “Though I only observed him and the deliberations for one day, I recognized him as a quiet, incredibly respected thought leader in the field. And I would have no idea I could hope to honor him in this way so many years ago.”

During his lecture, Camarata described his efforts to renew the use of the semi-sitting position for acoustic tumor resection. More than 25 years ago, he observed surgeries during training in Germany where the patient was positioned in a seated fashion. Camarata recently discovered the notes he took during the visit and wondered why the semi-sitting position wasn’t more popular.

The technique was once used by neurosurgeons routinely to remove tumors but has waned in use in recent decades, said Camarata. It is still widely used in Europe but not in the U.S. or Japan. Camarata recalled that he once received push back when he previously discussed using the semi-sitting position at his institution.

“Sitting positions are not the standard of care,” he said. “But this is something that needs to be explored and resolved in the U.S. for the benefit of the patients.”

Camarta estimated he has performed about 500 resections in his career and decided late in 2017 to use the sitting position for resection of all tumors greater than 1 centimeter. He has done five cases since then.

“To do the position correctly, the feet have to be literally at your head,” he said.

The sitting position has many advantages, including: better visualization of the operative field, quicker resections with less blood loss, better neurologic outcome (hearing/facial nerve), and it allows for cerebral spinal fluid and blood to run out, according to Camarata. One disadvantage of the procedure, he pointed out, is the time-consuming setup that can take more than 2 hours.

“I hope to convey the notion that even in neurosurgery, ‘you can teach an old dog new tricks,”’ he teased.

Camarata received his medical degree from the University of Kansas and completed his internship, residency, and fellowship in cerebrovascular and skull surgery at the University of Minnesota. He was a principal physician leader in the development of the Mid America (now St. Luke’s) Brain and Stroke Institute in Kansas City, and has maintained a robust practice in the treatment of cerebrovascular disease and skull base tumors in Kansas City, where he has practiced for the last 22 years.

—Glenda Shaw

About the Mealey Lecture

Dr. John Mealey, Jr., joined the surgical faculty of Indiana University School of Medicine in 1960. He became a full professor in 1969, serving in this capacity until his retirement in 2000. During the 40 years he served on the Indiana University Medical School faculty, he was involved in teaching medical students and resident physicians, research and neurosurgical practice. He spent many years at the original Riley Children’s Hospital and was a founding member of The Pediatric section of The American Association of Neurological Surgeons. He died March 22, 2017 after battling pancreatic cancer.

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