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Head fixation device complications

see Head fixation device complications in pediatric neurosurgery.

Pin fixation and rigid immobilization of the head is desirable in many neurosurgical procedures. However, these techniques are associated with complications in infants and young children. A simple modification of a commonly used cranial fixation system allows rigid, safe immobilization of the head in infants and children.

Beuriat et al. performed a literature review via PubMed and Google Scholar using the terms “Mayfield skull clamp”, “Sugita head holders”, “head holder complications” and “skull clamp complications”. Twenty-six complications directly related to the use of head holders were identified through 19 papers published from 1981 to 2014: mainly skull fractures with or without a dural laceration (50%), epidural hematomas (23.8%), skull fractures with or without a dural laceration (50%), and air embolism (9.5%). The authors propose recommendations for the safe use of head holders 1).

The Mayfield clamp, often causes brief intense nociceptive stimulation, hypertension and tachycardia. Blunting this response may help prevent increased intracranial pressure, cerebral aneurysm or vascular malformation rupture, and/or myocardial stress.

A remifentanil bolus is more effective than a propofol bolus in blunting hemodynamic responses to Mayfield placement, and possibly for other short, intense nociceptive stimuli 2).

Skull fracture 3) 4)

Epidural hematoma 5). 6).

Previous reports analyzed some of the complications associated with the application of this device for adults and children, even the indications for the use in pediatric are not well defined.

An 11-year-old girl diagnosed with non-communicating hydrocephalus, caused by a posterior fossa tumor. During the surgery, complications were found in the form of acute epidural hematoma due to head fixation pins. So, the operation was stopped. An emergent CT scan was carried out and showed a bilateral skull fracture and a massive right-sided epidural hematoma. An emergency craniotomy for clot removal was performed and five days later, a second surgery was carried out uneventfully for the residual tumor. The patient fully recovered after the second surgery.

Complications due to the use of a pinhead fixation are easier to occur in pediatric patients because the bones are thinner and need a more careful strategy when pinning. With prompt identification of any complications and earlier treatment, a good outcome will be achieved.

Parenrengi et al. compared this case report with published literature in order to suggest a way to prevent this complication.

Skull fractures and associated epidural hematomas in pediatric patients need to be considered as possible complications of the pin-type head fixation application. The head fixation devices in pediatric need to be used with great caution and knowing the risk factors, safe technique for application and management of complications will prevent a worse outcome 7).

Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders' - complications in neurosurgery: A review of the literature and recommendations for its use. Neurochirurgie. 2016 Dec;62(6):289-294. doi: 10.1016/j.neuchi.2016.09.005. Epub 2016 Nov 17. Review. PubMed PMID: 27865516.
Berger M, Philips-Bute B, Guercio J, Hopkins TJ, James ML, Borel CO, Warner DS, McDonagh DL. A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement. Curr Med Res Opin. 2014 Feb;30(2):243-50. doi: 10.1185/03007995.2013.855190. Epub 2013 Oct 30. PubMed PMID: 24161010.
Mohcine S, Brahim EM. Depressed skull fracture secondary to the Mayfield three-pin skull clamp. Pan Afr Med J. 2015 Mar 19;20:262. eCollection 2015. PubMed PMID: 26161185.
Matouk CC, Ellis MJ, Kalia SK, Ginsberg HJ. Skull fracture secondary to application of a Mayfield skull clamp in an adult patient: case report and review of the literature. Clin Neurol Neurosurg. 2012 Jul;114(6):776-8. doi: 10.1016/j.clineuro.2011.12.036. Epub 2012 Jan 18. PubMed PMID: 22261664.
Lee MJ, Lin EL. The use of the three-pronged Mayfield head clamp resulting in an intracranial epidural hematoma in an adult patient. Eur Spine J. 2010 Jul;19 Suppl 2:S187-9. doi: 10.1007/s00586-010-1323-z. Epub 2010 Feb 14. PubMed PMID: 20155477; PubMed Central PMCID: PMC2899644.
Yan HJ. Epidural hematoma following use of a three-point skull clamp. J Clin Neurosci. 2007 Jul;14(7):691-3. Epub 2007 Apr 25. PubMed PMID: 17462901.
Parenrengi MA, Adhiatmadja F, Arifianto MR, Apriawan T, Fauzi AA, Servadei F. Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: Case report and review of the literature. Int J Surg Case Rep. 2019 Aug 13;62:43-49. doi: 10.1016/j.ijscr.2019.07.079. [Epub ahead of print] PubMed PMID: 31445499.
head_fixation_device_complications.txt · Last modified: 2019/08/25 13:10 by administrador