Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children

• Published in: Child's nervous system Vol. 24; no. 8; pp. 917 - 923
• Main Authors: Vitali, Aleksander M., Steinbok, Paul
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-08-2008
• Subjects: Age Factors; Bone Nails - adverse effects; Child; Child, Preschool; Craniotomy - adverse effects; Craniotomy - instrumentation; Female; Head Movements; Hematoma, Epidural, Cranial - etiology; Humans; Immobilization - adverse effects; Immobilization - instrumentation; Intraoperative Complications - etiology; Male; Medicine; Medicine & Public Health; Neuronavigation - instrumentation; Neurosciences; Neurosurgery; Original Paper; Retrospective Studies; Skull Fracture, Depressed - etiology; Temporal Bone - injuries; Headrest; Pin; Epidural hematoma; Skull clamp; Complication; Skull fractures; Pediatric
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-008-0621-9

Objective
A head fixation device with pins is commonly used for immobilization of the patient’s head during craniotomy. The safety of head fixation devices in children has been discussed rarely in the literature. The purpose of this report is to review our experience with complications of head fixation with pins in children undergoing craniotomies and to review the literature on this subject.
Materials and methods
The database of the Division of Neurosurgery was reviewed to identify children who had cranial complications related to the use of a pin head fixation device. The charts of these patients were reviewed retrospectively.
Results
Five of 766 children (0.65%) undergoing craniotomies with pin fixation of the head had depressed skull fractures and/or epidural hematomas from the pin fixation. Age ranged from 2.6 to 7.5 years; all fractures were temporal and occurred during posterior fossa craniotomies.
Conclusions
Depressed skull fractures and associated epidural hematomas need to be considered as possible complications of pin fixation of the head for craniotomy in young children.