Respond of the different human cranial bones to pin-type head fixation device

Abstract

Background At this juncture, there is no consensus in the literature for the use and the safety of pin-type head holders in cranial procedures. Methods The present analysis of the bone response to the fixation of the instrument provides data to understand its impact on the entire skull as well as associated complications. An experimental study was conducted on fresh-frozen human specimens to analyze the puncture hole due to the fixation of each single pin of the pin-type head holder. Cone-beam CT images were acquired to measure the diameter of the puncture hole caused by the instrument according to several parameters: the pin angle, the clamping force, and different neurosurgical approaches most clinically used. Results The deepest hole, 2.67 ± 0.27 mm, was recorded for a 35° angle and a clamping force of 270 N at the middle fossa approach. The shallowest hole was 0.62 ± 0.22 mm for the 43° angle with a pinning force of 180 N in the pterional approach. The pterional approach had a significantly different effect on the depth of the puncture hole compared with the middle fossa craniotomy for 270 N pinning at 35° angle. The puncture hole measured with the 43° angle and 180 N force in prone position is significantly different from the other approaches with the same force. Conclusions These results could lead to recommendations about the use of the head holder depending on the patient’s history and cranial thickness to reduce complications associated with the pin-type head holder during clinical applications.

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

“…Interestingly, for the 36°/36° pin configuration plus the 40° rocker isolated, we found the deepest penetrations on the single-pin side for the middle fossa approach. This finding is congruous with the results of Visentin et al 9 . With the middle fossa approach, the single-pin hits the frontal bone basally near the air-filled sinuses, where bone density is also rather low.…”

“…A previous cadaveric study by Visentin et al analyzed cranial pin penetration depths of two commercially available pin-cone angles (35°: commercial adult pin; 43°: commercial pediatric pin) by means of cone beam CT images, assessing the single-pin side 9 . The group confirmed that the smaller pin-cone angle did result in deeper bone penetrations, and that bone penetration depth generally increased with the applied pin force (180 N to 270 N).…”

Lessons Learned about the Mayfield-Type Cranial Fixation System

“…Hiwatari et al 3 recommend that when using this fixation system in surgical procedures, the site of pin application, skull thickness, and fragility should be rigorously observed, along with appropriate control of compressive forces exerted by the head structure. Visentin et al [46] reached a conclusion in their study regarding the recommendation for head support use, which depends on the patient's history and cranial thickness to reduce complications associated with pin-type head support during clinical application.…”