Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: Case report and review of the literature

Parenrengi, Muhammad Arifin; Adhiatmadja, Fatkhul; Arifianto, Muhammad Reza; Apriawan, Tedy; Fauzi, Asra Al; Servadei, Franco

doi:10.1016/j.ijscr.2019.07.079

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…Complications related to the usage of head pins are quite uncommon ranging from 0.65 to 1.1% and are frequently seen in the pediatric population due to the variability and inconsistency in the thickness of the developing cranial vault, especially the squamous temporal bone, frontal sinus, and coronal suture. 2 Thinning of the cranial vault may also be seen in adults with long-standing intracranial hypertension or those on high-dose antiepileptic drugs, 2 both of which were absent in our patient. The coagulation profile was also reported to be normal.…”

Section: Key Messagementioning

confidence: 50%

See 1 more Smart Citation

Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma

Reddy

Panda

Chauhan

et al. 2023

Indian Journal of Neurotrauma

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Head fixation devices are frequently used to immobilize the position of the head in neurosurgery. We report a rare complication of a four-pin Sugita device causing epidural hematoma (EDH) in a young adult male undergoing transcranial excision of a craniopharyngioma manifesting intraoperatively as an intractable tense brain. Decreased bone mineral density secondary to the metabolic consequences of craniopharyngioma could have increased the susceptibility to breach of the bony cortex. The index case highlights the essential role of a preoperative computed tomography (CT) scan review for the thickness of the cranial vault and the identification of weaker zones in high-risk groups.

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Section: Key Messagementioning

confidence: 50%

“…Many modifications of head pin fixation systems have been described like the use of rubber plugs, plaster of Paris cast interface, and usage of six pins or a padded horseshoe headrest simultaneously to equally disperse the forces. 2 These modifications still do not completely eliminate the risk of slippage of the pins.…”

mentioning

confidence: 99%

Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma

Reddy

Panda

Chauhan

et al. 2023

Indian Journal of Neurotrauma

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“…According to the results of this study, especially in pediatric cases, the complications of the 3 pin head clamps are not as low as expected according to the literature. We think that this difference may occur as a result of surgeons avoiding reporting complications [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Intracranial epidural hematoma after use of a 3-pin head clamp in a pediatric case with posterior fossa tumor and hydrocephalus: A case report

Şahin¹,

Zeynal²,

Karaavci³

et al. 2021

J Clin Invest Surg.

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The head clamp system is one of the indispensable equipment of neurosurgery in terms of stabilizing the head and positioning it. In addition, in neurosurgery clinics, the use of pin head clamp is required to use the navigation system effectively. In pediatric cases, complications after the use of pins head clamp are rare, as reported in the literature. This paper presents a pediatric patient with posterior fossa tumor and hydrocephalus, who developed depression fracture and epidural hematoma after the use of Mayfield 3-pin clamp head. For this reason, the patient underwent emergency surgery a second time and the epidural hematoma was evacuated to obtain decompression. Epidural bleeding, which is a complication of the pinned clamped head, is frequently described in the literature, often in the pediatric cases accompanied by posterior fossa tumor and hydrocephalus. In this type of pediatric cases, a safe study for the use of pin clamp head is not yet available in the literature.

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“…Those include forceful maneuvers during bone work, unintentional pressing on the HFD, repositioning of the table intraoperatively and unexpected body movements of the patient 2 . Skull fractures and their resulting comorbidities could be traced back to an inadequate application of pin force 6 , 7 .…”

Section: Introductionmentioning

confidence: 99%

Pin penetration depths in the neurocranium using a three-pin head fixation device

Machts,

Schindler,

Unterhauser-Chwastek

et al. 2024

Sci Rep

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In estimated 10–15% of neurosurgical interventions employing a conventional three-pin head fixation device (HFD) the patient’s head loses position due to slippage. At present no scientifically based stability criterion exists to potentially prevent the intraoperative loss of head position or skull fractures. Here, data on the skull penetration depth both on the single and two-pin side of a three-pin HFD are presented, providing scientific evidence for a stability criterion for the invasive three-pin head fixation. Eight fresh, chemically untreated human cadaveric heads were sequentially pinned 90 times in total in a noncommercially calibrated clamp screw applying a predefined force of 270 N (approximately 60 lbf) throughout. Three head positions were pinned each in standardized manner for the following approaches: prone, middle fossa, pterional. Titanium-aluminum alloy pins were used, varying the pin-cone angle on the single-pin side from 36° to 55° and on the two-pin side from 25° to 36°. The bone-penetration depths were directly measured by a dial gauge on neurocranium. The penetration depths on the single-pin side ranged from 0.00 mm (i.e., no penetration) to 6.17 mm. The penetration depths on the two-pin side ranged from 0.00 mm (no penetration) to 4.48 mm. We measured a significantly higher penetration depth for the anterior pin in comparison to the posterior pin on the two-pin side in prone position. One pin configuration (50°/25°) resulted in a quasi-homogenous pin depth distribution between the single- and the two-pin side. Emanating from the physical principle that pin depths behave proportionate to pin pressure distribution, a quasi-homogenous pin penetration depth may result in higher resilience against external shear forces or torque, thus reducing potential complications such as slippage and depressed skull fractures. The authors propose that the pin configuration of 50°/25° may be superior to the currently used uniform pin-cone angle distribution in common clinical practice (36°/36°). However, future research may identify additional influencing factors to improve head fixation stability.

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Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: Case report and review of the literature

Cited by 6 publications

References 24 publications

Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma

Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma

Intracranial epidural hematoma after use of a 3-pin head clamp in a pediatric case with posterior fossa tumor and hydrocephalus: A case report

Pin penetration depths in the neurocranium using a three-pin head fixation device

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