Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child

ABSTRACTCranial fixation with pins is a routine adjunct in neurosurgery and is usually considered safe. A rarely reported complication is skull fracture at the pin site and consequent epidural hematoma. Usually, these are picked up only postoperatively and rarely, intraoperatively if there is unexplained “brain bulge” in which case the operation should be terminated and urgent imaging has to be done. We describe such a complication that occurred while operating on a 12-year-old child with a posterior fossa tumor and review the available literature dealing with such events.

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

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.17 ◽

2021 ◽

Vol 6 (2) ◽

pp. 178-182.

Author(s):

Mehmet Hakan Şahin ◽

◽

Mete Zeynal ◽

Nuh Çağrı Karaavcı ◽

Mehmet Kürşat Karadağ

Keyword(s):

Case Report ◽

Pediatric Patient ◽

Posterior Fossa ◽

Navigation System ◽

Emergency Surgery ◽

Epidural Hematoma ◽

Posterior Fossa Tumor ◽

Pediatric Case ◽

Epidural Bleeding ◽

Head Clamp

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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Sudden and Persistent Bradycardia: An Unexpected Indicator of Pin-Site Extradural Hematoma in a Pediatric Patient

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0038-1660691 ◽

2018 ◽

Vol 05 (03) ◽

pp. 187-189

Author(s):

Roneeta Nandi ◽

Shruti Redhu ◽

Rana Patir ◽

Hari Hara Dash

Keyword(s):

Early Detection ◽

Pediatric Patient ◽

Posterior Fossa ◽

Skull Fracture ◽

Warning Sign ◽

Brain Swelling ◽

Extradural Hematoma ◽

Tumor Excision ◽

Pin Fixation ◽

Pin Site

AbstractDepressed skull fracture and extradural hematoma are infrequent complications of skull pin fixation in children undergoing craniotomy. Neurosurgeons are often alerted about these complications by intraoperative brain swelling or postoperative neurological deterioration. We describe the development of pin-site extradural hematoma in a child on whom Mayfield skull clamp was applied during posterior fossa tumor excision. Sudden and persistent bradycardia observed by the anesthesiologist served as the sole warning sign. Such an on-table indicator of pin-site extradural hematoma has not been described earlier. The anesthesiologist must maintain vigilance and effective communication with surgical colleagues to ensure early detection and timely management of these pin-site complications.

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