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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.
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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
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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]
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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.
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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
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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.
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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
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Shen B, Hu C, Jia L, Hu Y. Acute cerebral venous outflow obstruction during convexity meningioma resection. Int J Neurosci 2020; 132:100-106. [PMID: 32729769 DOI: 10.1080/00207454.2020.1802264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebral venous outflow obstruction involves idiopathic intracranial hypertension, and the most common related condition is dural venous sinus stenosis or, in other words, an obstruction of the dural venous sinuses. In these cases, the pathological process is often chronic, displays only mild symptoms, and rarely requires urgent surgical intervention. In this study, we present a unique case involving an acute cerebral venous outflow obstruction that occurred during meningioma resection that ultimately had catastrophic consequences. MATERIALS AND METHODS The patient's preoperative imaging only revealed an unremarkable frontal convexity meningioma with an average diameter exceeding 8 cm. She was admitted for a scheduled right frontoparietal craniotomy for lesion resection. RESULTS The patient's unique congenital dural venous sinus structure along with a non-surgical epidural hematoma both contributed to a catastrophic outcome, causing a progressive hemispheric encephalocele, significant blood loss, and wound closure difficulties. CONCLUSION Neurosurgeons should place an additional focus on cerebral venous outflow patency during tumor resection, even if the tumor does not involve the transverse or sigmoid sinuses. It is well known that the tacking sutures play an essential role in preventing an epidural hematoma, but the procedure to mitigate hematomas occurring outside the surgical field of view is not fully recognized by neurosurgeons. If dural tacking sutures are placed after complete tumor resection, the prophylactic effect for preventing EDH in the non-surgical areas may not be guaranteed. Therefore, we strongly advocate for the tacking sutures to be accurately placed before dural incisions are made.
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Affiliation(s)
- Bo Shen
- Department of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, China.,Academic Department of Neurosurgery, Shanxi Medical University, Taiyuan, China
| | - Changchen Hu
- Department of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Liming Jia
- Department of Anesthesiology, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Yanjun Hu
- Magnetic Resonance Center, Shanxi Provincial Peoples Hospital, Taiyuan, China
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Extradural Hemorrhage Secondary to Skull Pin Fixation Manifesting as Intractable Intraoperative Brain Swelling. J Neurosurg Anesthesiol 2017; 29:375-376. [DOI: 10.1097/ana.0000000000000330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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.
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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
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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.
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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
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Bindra A, Rath GP, Chowdhury T, Mishra P. Epidural hematoma at skull pin fixation sites may cause refractory intraoperative brain bulge. J Clin Anesth 2012; 24:509-10. [DOI: 10.1016/j.jclinane.2011.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 09/06/2011] [Accepted: 09/09/2011] [Indexed: 11/17/2022]
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