1
|
Plevko M, Vybíhal V, Sova M, Fadrus P, Smrčka M. Epidural Hematoma, a Rare Complication After the Use of Mayfield Clamp: A Case Report and Review of the Literature. Korean J Neurotrauma 2023; 19:471-479. [PMID: 38222839 PMCID: PMC10782104 DOI: 10.13004/kjnt.2023.19.e39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 01/16/2024] Open
Abstract
Herein, we describe a case of epidural hematoma associated with the use of a Mayfield head clamp. An 18-year old patient with an upper brainstem tumour causing obstructive hydrocephalus underwent a routine third ventriculostomy, which unexpectedly revealed an intracranial hemorrhage. We outline potential risk factors, propose an algorithm for preventing complications associated with the use of pin-type fixation, and conducted a structured review of the literature to identify similar clinical scenarios.
Collapse
Affiliation(s)
- Martin Plevko
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Václav Vybíhal
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Marek Sova
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Pavel Fadrus
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| | - Martin Smrčka
- Department of Neurosurgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, University Hospital Brno, Brno, Czech Republic
| |
Collapse
|
2
|
Endoscopic microvascular decompression without the use of rigid head fixation. J Clin Neurosci 2022; 106:213-216. [DOI: 10.1016/j.jocn.2022.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022]
|
3
|
Yamaguchi H. Gamma Knife Radiosurgery With Mask Fixation Under General Anesthesia for Pediatric Patients. Cureus 2022; 14:e20905. [PMID: 35145809 PMCID: PMC8810120 DOI: 10.7759/cureus.20905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
Gamma knife radiosurgery (GKS) is performed on children by frame fixation of the skull under general anesthesia. With the introduction of the Gamma Knife Icon, treatment by fixing with a thermoplastic mask has become possible. In this study, we performed GKS by mask fixation under general anesthesia, measured the accuracy, and examined whether an accuracy equivalent to that of frame fixation could be guaranteed. We included three children who underwent mask fixation under general anesthesia between September and November 2020. After the induction of general anesthesia, a patient marker was attached to the nose, and the movement of the marker before mask fixation was measured using a real-time high-definition motion management (HDMM) system. The movement of the patient marker from the start to the end of treatment after mask fixation was monitored and measured. After the induction of general anesthesia, the movement of the patient marker was ≤0.3 mm in two cases and ≥1.0 mm in one case without mask fixation. When the mask was fixed, it was ≤0.2 mm in all three cases. It was confirmed that the marker could move even under general anesthesia without mask fixation, and it could be suppressed to a minimum after mask fixation. With the mask fixation method devised in this study, GKS under general anesthesia for children seems to be a safe and highly accurate method.
Collapse
|
4
|
Hiwatari T, Yamahata H, Yonenaga M, Fujio S, Higa N, Hanaya R, Arita K, Yoshimoto K. The Incidence of Depressed Skull Fractures Due to the Use of Pin-Type Head Frame Systems in the Adult Population: 10-year Experience of a Single Neurosurgical Center. World Neurosurg 2021; 155:e395-e401. [PMID: 34425293 DOI: 10.1016/j.wneu.2021.08.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Pin-type head frame systems have become a worldwide standard procedure, but they can cause some complications on rare occasions. This study aimed to examine the incidence and associated risk factors of depressed skull fracture and related intracranial hematoma (DSFH) due to the use of head frames in our institute over the past 10 years. METHODS This study included 1749 patients who underwent neurosurgical surgeries using pin-type head frames, including the Mayfield (Integra NeuroSciences, Plainsboro, NJ) skull clamp (721 cases) and the Sugita (Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) head frame (1028 cases). We retrospectively reviewed hospital records of our institute to identify cases of DSFH, and documented the type of head frame used, as well as patient characteristics. RESULTS The incidence of DSFH was 0.29% (5 of 1749 cases). All 5 cases had an associated epidural hematoma, with a single case having an additional dural laceration (without subdural damage). All perforation sites, located at the parietal bone near the pterion, occurred by the unilateral horizontal screw of the Sugita head frame. None of the patients experienced postoperative neurological decline. CONCLUSIONS Even in the adult population, the DSFH by the pin-type head frame can occur infrequently. Based on our results, we recommend that the following factors should be considered when the pin-type head frame is used for neurosurgical procedures: location of pin application, thickness and fragility of the skull, and adequate control of compressive forces exerted by the head frame.
Collapse
Affiliation(s)
- Takaaki Hiwatari
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shingo Fujio
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Izumi Regional Hospital, Kagoshima, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
5
|
Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg 2021; 151:102-109. [PMID: 33940273 DOI: 10.1016/j.wneu.2021.04.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications. METHODS PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complications clearly attributed to the Mayfield skull clamp. Both authors assessed all search results for eligibility. Additional articles were found with cross-references. RESULTS The most common complications associated with Mayfield clamp application were due to vascular injury inflicted by the pins or skull fractures. Complications related to use of the Mayfield clamp were rare but often serious and avoidable. A conceptual framework was presented on how to avoid these complications. CONCLUSIONS Attention to detail, anatomy, and the primum non nocere principle are imperative in every step of the neurosurgical pathway, including placement of the Mayfield skull clamp. Thoughtful application, taking into consideration several nuances, is recommended to avoid inadvertent patient harm.
Collapse
Affiliation(s)
- Dieter Thijs
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
| |
Collapse
|
6
|
Furuya T, Yamazaki M, Nemoto T, Okawa A, Ohtori S. Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report. J Med Case Rep 2021; 15:154. [PMID: 33832515 PMCID: PMC8033709 DOI: 10.1186/s13256-021-02776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mayfield skull clamps are widely used and indispensable in current neurosurgery. Complications such as skull fractures or intracranial hematoma from using a Mayfield skull clamp have largely been reported in the pediatric population, are likely related to the relative thinness of the skull, such as in patients with hydrocephalus, and are extremely rare in adults. Here, we report a case of skull fracture and epidural hematoma caused by a Mayfield skull clamp used for posterior decompression surgery in an adult patient with chronic hemodialysis. CASE PRESENTATION A 67-year-old Asian male patient with a history of dialysis-dependent chronic renal failure over 36 years suffered from severe cervical myelopathy. Neurological examination and radiographic images revealed cervical spondylotic myelopathy due to dialysis-related spondyloarthropathy. Laminoplasty was planned on patient consent. A Mayfield skull clamp was applied with the patient supine. Torque was applied to the screws with gentle care, but there was no resistance and it was not easy to reach the standard 60 lb (267 N) to 80 lb (356 N). Because a skull fracture was suspected, we canceled the surgery. Emergency head computed tomography showed depressed skull fractures underlying the single-pin sites with an associated epidural hematoma. The fractures and epidural hematoma were treated conservatively, and spontaneous resolution of the hematoma was confirmed. Cervical laminoplasty was performed successfully using a mask-type head holder on the subsequent day. CONCLUSIONS As a precaution for fractures and epidural hematoma in neurosurgical patients with bone fragility or a thin skull, use of a mask-type fixing device or halo ring is recommended.
Collapse
Affiliation(s)
- Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan.
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tenodai, Tsukuba-shi, Ibaraki, 305-8575, Japan
| | - Tetsuharu Nemoto
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai, Sakura-shi, Chiba, 285-8765, Japan
| | - Akihiko Okawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan
| |
Collapse
|
7
|
Visentin A, van Dooren K, Mertens J, Brina O, Schaller K. Respond of the different human cranial bones to pin-type head fixation device. Acta Neurochir (Wien) 2021; 163:885-893. [PMID: 33515124 PMCID: PMC7966194 DOI: 10.1007/s00701-021-04728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022]
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.
Collapse
Affiliation(s)
- Alissa Visentin
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
| | - Kristina van Dooren
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| | - Jan Mertens
- Black Forest Medical Group, Freiburg, Germany
| | - Olivier Brina
- Division of Neuroradiology, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, University of Geneva, Swiss Foundation for Innovation & Training in Surgery (SFITS), Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland
| |
Collapse
|
8
|
Menger R, Lin J, Cerpa M, Lenke LG. Epidural hematoma due to Gardner-Wells Tongs placement during pediatric spinal deformity surgery. Spine Deform 2020; 8:1139-1142. [PMID: 32314179 DOI: 10.1007/s43390-020-00116-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To our knowledge, this is the first documented report of an operative cranial epidural hematoma secondary to skull fracture due to placement of Gardner-Wells Tongs (GWT) in the setting of a spinal deformity reconstruction. PURPOSE The objective is to illustrate the possibility of cranial pathology secondary to GWT placement and the need to properly correlate intraoperative neuromonitoring findings. STUDY DESIGN Case report. METHODS A 14-year-old male with Marfan's Syndrome presented for three-column osteotomy spinal reconstruction for a large and stiff thoracic kyphoscoliosis. Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability without issue. During the lumbar posterior column osteotomies the patient began to lose upper and lower extremity motor data. This indicated a cranial pathology. A temporary rod was placed on the concavity and an emergent flip without closure was performed. Upon flip, the patient was fixed and dilated with only right corneal reflex. The patient was rushed to the CT scanner where a large right-sided epidural hematoma was noted with a temporal bone fracture at the pin site, with the patient's right temporal bone noted to be only 1.3 mm in thickness. RESULTS The patient underwent emergent epidural hematoma evacuation by the Neurosurgical team. The patient was discharged to rehabilitation 1 week after his cranial epidural hematoma surgery with a complete recovery including with full strength examination of all extremities. He subsequently underwent a definitive posterior spinal fusion with posterior column osteotomies 8 weeks later. CONCLUSION Cranial pin fixation has the rare possibility to produce cranial pathology and has a specific complication protocol. Proper utilization and interpretation of neuromonitoring is essential to aid in intraoperative decision-making.
Collapse
Affiliation(s)
- Richard Menger
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - James Lin
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| | - Meghan Cerpa
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA.
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY, 10034, USA
| |
Collapse
|
9
|
LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr 2020; 26:98-103. [PMID: 32276245 DOI: 10.3171/2020.1.peds19541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022]
Abstract
Head immobilization devices with skull pins are commonly used by neurosurgeons to stabilize the head for microsurgical techniques and to maintain accurate intraoperative neuronavigation. Pediatric patients, who may have open fontanelles, unfused sutures, and thin skulls, are vulnerable to complications during placement in pins. We review the various methods of pinning in pediatric neurosurgery and revisit the modified rubber stopper technique using a commonly available rubber stopper from a medication bottle over a standard adult pin of a Mayfield head clamp to prevent the pins from plunging through the thin pediatric skull.
Collapse
Affiliation(s)
- Melissa A LoPresti
- 1Department of Neurosurgery, Baylor College of Medicine, Houston.,2Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Joshua Nguyen
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and.,4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Sandi K Lam
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and.,4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| |
Collapse
|
10
|
Pradhan RR, Shrestha GS, Sedain G. Remote Supratentorial Subdural Hematoma Following Craniectomy and Evacuation of Hypertensive Cerebellar Hematoma. Cureus 2020; 12:e6977. [PMID: 32201656 PMCID: PMC7075514 DOI: 10.7759/cureus.6977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Remote acute subdural hematoma following a decompressive craniotomy or craniectomy is a rare phenomenon. Only few cases of postoperative contralateral acute subdural hematomas have been reported in the literature review till date. This case report details a case of a 32-year-old hypertensive male who presented with severe headache, multiple episodes of vomiting, slurring of speech, nystagmus and ataxic gait for one day. Computed tomography (CT) scan of head revealed a right sided cerebellar hemorrhage with effacement of fourth ventricle and upstream hydrocephalus. A right suboccipital craniectomy and hematoma evacuation were performed. A repeat CT scan of head was done at six hours post surgery; which revealed a contralateral (left-sided) subdural hematoma involving the fronto-parieto-temporal region. The patient improved following conservative management. Contralateral acute subdural hematoma following evacuation of hematoma is a rare, but a potentially life-threatening complication; therefore, we should try to detect such contralateral hematoma and prevent clinical deterioration.
Collapse
Affiliation(s)
- Ravi R Pradhan
- Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| | - Gentle S Shrestha
- Critical Care, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, NPL
| | - Gopal Sedain
- Neurosurgery, Tribhuvan University Institute of Medicine, Kathmandu, NPL
| |
Collapse
|
11
|
Alexander H, Fayed I, Oluigbo CO. Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations. Oper Neurosurg (Hagerstown) 2019; 18:614-620. [DOI: 10.1093/ons/opz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness.
OBJECTIVE
To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG.
METHODS
Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation.
RESULTS
We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted.
CONCLUSION
Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.
Collapse
Affiliation(s)
- Hepzibha Alexander
- Children's National Medical Center, Department of Neurosurgery, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Islam Fayed
- Children's National Medical Center, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chima O Oluigbo
- Children's National Medical Center, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| |
Collapse
|
12
|
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; 62:43-49. [PMID: 31445499 PMCID: PMC6717090 DOI: 10.1016/j.ijscr.2019.07.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/04/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION A head fixation device containing pins is common equipment used in neurosurgical procedures. Previous reports analysed 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. CASE PRESENTATION An 11-year-old girl diagnosed with non-communicating hydrocephalus, caused by 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. 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. DISCUSSION Complications due to the use of a pin head fixation are easier to occur in pediatric patients, because the bones are thinner and need more carefull strategy when pinning. With promp identification of any complications and earlier treatment, the good outcome will be achieved. We compared our case report with published literature in order to suggest the way to prevent this complication. CONCLUSION 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 worse outcome.
Collapse
Affiliation(s)
- M Arifin Parenrengi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Fatkhul Adhiatmadja
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Muhammad Reza Arifianto
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Tedy Apriawan
- Department of Neurosurgery, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia.
| | - Franco Servadei
- Department of Neurosurgery, Humanitas University-Research Institute, Milan, Italy.
| |
Collapse
|
13
|
Zaazoue MA, Bedewy M, Goumnerova LC. Complications of Head Immobilization Devices in Children: Contact Mechanics, and Analysis of a Single Institutional Experience. Neurosurgery 2017; 82:678-685. [DOI: 10.1093/neuros/nyx315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Head immobilization devices (HIDs) are a staple of neurosurgical procedures, including in the intraoperative magnetic resonance imaging (iMRI) operating rooms (ORs) where material modifications were necessary for compatibility with the magnets utilized.
OBJECTIVE
To present the experience in this OR environment and discuss the multifactorial nature of the observed adverse events.
METHODS
A retrospective chart review was performed, utilizing the Department of Neurosurgery and iMRI OR databases to identify patients who suffered complications related to HIDs between November 2007 and March 2016. A literature review was also done to identify the magnitude of the problem and the availability of safety guidelines.
RESULTS
Nine hundred and forty patients underwent surgery in the iMRI OR requiring head immobilization. Seven (0.7%) suffered complications related to the HID—depressed skull fractures (n = 7) and epidural hematomas (n = 6). Age at surgery ranged from 1.6 to 10.3 yr. All patients had posterior fossa neoplasms and associated obstructive hydrocephalus. Four patients (57%) suffered permanent neurological deficits. Six patients (86%) underwent a surgical procedure to evacuate the epidural hematomas and repair the depressed skull fracture. In contrast, 1 out of 445 patient (0.2%) suffered HID-related adverse events in the conventional ORs, aged 10.2 yr.
CONCLUSION
HIDs are important to provide stability and support during neurosurgical procedures. Modifications in the material or the shape of the pins can significantly change the pressure exerted. Most of these complications are preventable if certain precautionary measures are taken especially in certain high-risk patients, and the overall benefits of HIDs continue to outweigh the risks. There is a need for consensus on guidelines for the safe use of these devices.
Collapse
Affiliation(s)
- Mohamed A Zaazoue
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mostafa Bedewy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
14
|
Araki T, Yokota H, Morita A. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurol Med Chir (Tokyo) 2017; 57:82-93. [PMID: 28111406 PMCID: PMC5341344 DOI: 10.2176/nmc.ra.2016-0191] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in children. Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology. In addition, recent technical advances in diagnostic imaging of pediatric TBI has facilitated accurate diagnosis, appropriate treatment, prevention of complications, and helped predict long-term outcomes. Here a review of recent studies relevant to important issues in pediatric TBI is presented, and recent specific topics are also discussed. This review provides important updates on the pathophysiology, diagnosis, and age-appropriate acute management of pediatric TBI.
Collapse
Affiliation(s)
- Takashi Araki
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | | | | |
Collapse
|
15
|
Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders' - complications in neurosurgery: A review of the literature and recommendations for its use. Neurochirurgie 2016; 62:289-294. [PMID: 27865516 DOI: 10.1016/j.neuchi.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Abstract
Several types of headholders are routinely used in neurosurgical practice to secure the head in a precise position, providing better security during surgical dissection as well as an absence of eye compression during prone positions. Nevertheless, potentially lethal complications might occur. We performed a review of the literature via PubMed and Google Scholar using the terms "Mayfield skull clamp", "Sugita headholders", "headholder complications" and "skull clamp complications". Twenty-six complications directly related to the use of headholders 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 headholders.
Collapse
Affiliation(s)
- P-A Beuriat
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - T Jacquesson
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - E Jouanneau
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France
| | - M Berhouma
- Skull base surgery unit, department of neurosurgery B, Pierre-Wertheimer neurological and neurosurgical hospital, hospices civils de Lyon, 59, boulevard Pinel, 69394 Lyon cedex 03, France.
| |
Collapse
|
16
|
Moutaoukil M, Bensghir M, Eddik S, Jaafari A, Ahtil R, Meziane M, Haimeur C. [Depressed skull fracture following the use of Mayfield headrest in adult patients: about a case and review of the literature]. Pan Afr Med J 2016; 24:129. [PMID: 27642467 PMCID: PMC5012808 DOI: 10.11604/pamj.2016.24.129.8367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/01/2015] [Indexed: 11/11/2022] Open
Abstract
Un grand nombre d'interventions neurochirurgicales nécessitent l'utilisation d'une têtière à broches pour immobiliser la tête du patient. Nous rapportons le cas d'une embarrure chez un adulte secondaire à l'utilisation de la têtière de Mayfeild. Le diagnostic a été posé en postopératoire d'une résection chirurgicale d'un médulloblastome par une tomodensitométrie cérébrale. Plusieurs facteurs semblent contribuer à augmenter le risque de complications dues à l'utilisation de la têtière de Mayfield. Les mesures de prévention sont discutées à travers une revue de littérature.
Collapse
Affiliation(s)
- Mohamed Moutaoukil
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mustapha Bensghir
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Soukaina Eddik
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Abdelhamid Jaafari
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Redouane Ahtil
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Mohammed Meziane
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| | - Charki Haimeur
- Service d'Anesthésiologie, Hôpital Militaire Med V, Université Souissi Med V, Rabat, Maroc
| |
Collapse
|
17
|
van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, Delye H. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr 2016; 18:363-71. [PMID: 27231823 DOI: 10.3171/2016.3.peds15679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.
Collapse
Affiliation(s)
| | - Sebastian Arts
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura M Blok
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mark P Hendriks
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Luc Tielens
- Anesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | |
Collapse
|
18
|
Krishnan P, Kumar SK, Kartikueyan R, Patel SM. Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract 2016; 7:286-9. [PMID: 27114664 PMCID: PMC4821941 DOI: 10.4103/0976-3147.178661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Cranial 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.
Collapse
Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Soumen Kanti Kumar
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | - Rajaraman Kartikueyan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
| | | |
Collapse
|
19
|
Boop FA, Bate B, Choudhri AF, Burkholder B, Klimo P. Preliminary experience with an intraoperative MRI-compatible infant headholder: technical note. J Neurosurg Pediatr 2015; 15:539-43. [PMID: 25679382 DOI: 10.3171/2014.10.peds14447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of high-quality intraoperative MRI (iMRI) capability has offered a major advance in the care of patients with complex intracranial disease. To date, this technology has been limited by the need for pin fixation of the calvaria. The authors report their preliminary experience with an MRI-compatible horseshoe headrest that allows for the following: 1) iMRI in patients too young for pin fixation; 2) iMRI in patients with large calvarial defects; 3) the ability to move the head during iMRI surgery; and 4) the use of neuronavigation in such cases. The authors report 2 cases of infants in whom the Visius Surgical Theatre horseshoe headrest (IMRIS Inc.) was used. Image quality was equivalent to that of pin fixation. The infants suffered no skin issues. The use of neuronavigation with the system remained accurate and could be updated with the new iMRI information. The Visius horseshoe headrest offers a technical advance in iMRI technology for infants, for patients with cranial defects or prior craniotomies in whom pin fixation may not be safe, or for patients in whom the need to move the head during surgery is required. The image quality of the system remains excellent, and the ability to merge new images to the neuronavigation system is helpful.
Collapse
|
20
|
Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases. Clin Neurol Neurosurg 2014; 130:42-7. [PMID: 25576884 DOI: 10.1016/j.clineuro.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. METHODS All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. RESULTS The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. CONCLUSION Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.
Collapse
|
21
|
Roth J, Galeano E, Milla S, Hartmannsgruber MW, Weiner HL. Multiple epidural hematomas and hemodynamic collapse caused by a subgaleal drain and suction-induced intracranial hypotension: case report. Neurosurgery 2011; 68:E271-5; discussion E276. [PMID: 21099705 DOI: 10.1227/neu.0b013e3181fe6165] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Subgaleal drains are commonly used in neurosurgery. Rare complications attributed to these drains have been described. We present a rare complication of hemodynamic collapse and multiple epidural hematomas attributed to intracranial hypotension induced by a subgaleal drain connected to suction during wound closure. CLINICAL PRESENTATION A 3.5-year-old boy underwent an uneventful occipital lobectomy and titanium mesh cranioplasty for resection of a recurrent choroid plexus carcinoma. The child had undergone 2 uneventful previous resections and cranial irradiation. During skin closure, a subgaleal drain was connected to suction to keep the surgical bed dry. Immediately after completion of the subgaleal layer closure, there was an acute hemodynamic collapse, accompanied by bradycardia and a drop in the hematocrit. After successful resuscitation, the child underwent a brain computed tomography scan that showed a large bifrontal epidural hematoma and multiple additional small epidural hematomas. The large hematoma was surgically evacuated, and the child had an uneventful recovery. CONCLUSION Acute negative intracranial hypotension may cause bradycardia, epidural hematomas, and hemodynamic collapse. Subgaleal drains should not be connected to suction systems, and care should be taken when these drains are connected to vacuum bulbs in high-risk cases such as after cranial irradiation, large resections, and mesh cranioplasties.
Collapse
Affiliation(s)
- Jonathan Roth
- Department of Neurosurgery, Division of Pediatric Neurosurgery, NYU Langone Medical Center, New York, New York 10016, USA.
| | | | | | | | | |
Collapse
|
22
|
Depressed skull fracture by a three-pin head holder: a case illustration. Childs Nerv Syst 2011; 27:163-5. [PMID: 20574740 DOI: 10.1007/s00381-010-1213-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED BACKGROUND AND CASE REPORT: Many surgical procedures require a rigid immobilization of the patients' head, which is usually achieved by using a pin-type head holder. We briefly illustrate the case of a 4-year-old girl who sustained a depressed skull fracture by penetration of a pin of the head holder. The fracture was noted at the end of the surgery performed for treatment of a cerebellar astrocytoma and was managed conservatively. DISCUSSION Several factors seem to be involved in the production of this complication as are faulty application of the pins, excessive pin pressure, skull thinning, young patient's age, and pathological conditions that evolve with long-standing raised intracranial pressure. Prevention and management measures are briefly discussed.
Collapse
|
23
|
Jha NK, Ebrahim S, Fallah A, Cenic A, De Villiers RA. Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium. Br J Neurosurg 2009; 23:211-2. [DOI: 10.1080/02688690802434830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
24
|
Serramito-García R, Arcos-Algaba A, Santín-Amo J, García-Allut A, Bandín-Diéguez F, Gelabert-González M. Hematoma epidural secundario al empleo de cabezal autoestático en un adulto. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70139-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|