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Use of cranial fixation pins in pediatric neurosurgery
Cherisse Berry1, David I Sandberg, Daniel J Hoh
1Division of Neurosurgery, Childrens Hospital Los Angeles, and Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Insights
Pediatric neurosurgeons commonly use cranial fixation pins, but guidelines are lacking. This study highlights the need for standardized practices to prevent complications in children.
Area of Science:
- Neurosurgery
- Pediatric Medicine
- Medical Devices
Background:
- Cranial fixation pins are essential in neurosurgery.
- Current parameters for pediatric use are not well-defined.
- Developing crania in children require age-specific considerations.
Purpose of the Study:
- To survey neurosurgeons on their experience with cranial fixation pins in pediatric patients.
- To identify current practices and complications associated with pediatric cranial fixation.
- To suggest potential guidelines for safe pin application in children.
Main Methods:
- A 30-item multiple-choice survey was emailed to 605 pediatric neurosurgeons.
- Survey questions covered patient age, pin selection, pressure applied, and complications.
- Institutional Review Board approval was obtained.
Main Results:
- 96% of responding neurosurgeons use cranial fixation pins in pediatric practice.
- Many surgeons apply pins to children aged 1-4 years, with varying pressure ranges.
- 54% reported complications, including fractures and hematomas; 94% are unaware of standard guidelines.
Conclusions:
- Cranial fixation pins are frequently used in children under 5.
- Lack of defined guidelines contributes to significant complications.
- Standardized practices are needed for safe pediatric cranial fixation.
Objective:
Cranial fixation using pins during neurosurgical procedures is commonplace; however, parameters for the application of these devices in pediatric patients are not well defined. Variability in the thickness of the developing cranium necessitates age-specific considerations to reduce the risk of adverse events. To suggest possible guidelines for the use of cranial fixation pins in children, we surveyed neurosurgeons treating pediatric patients regarding their experience with such devices.
Methods:
An Institutional Review Board-approved, 30-item multiple choice survey was provided by electronic mail to 605 neurosurgeons treating pediatric patients. The survey included specific questions regarding their experience with cranial fixation pins with respect to age ranges of patients, selection of pin size, type of pin pressure applied, and complications encountered.
Results:
One hundred sixty-four (27%) responses were received. One hundred fifty-eight of the 164 (96%) neurosurgeons reported using cranial fixation pins in their pediatric practice. Forty-four of the 164 (27%) apply fixation pins in patients aged 1 to 2 years. Eighty-two (50%) apply pins in patients aged 2 to 3 years, and 89 (54%) apply pins in patients aged 3 to 4 years. For patients aged 2 to 5 years old, the majority of responders use between 10 and 40 pounds of pressure, whereas for those older than 5 years of age, most use between 30 and 40 pounds of pressure. After age 10, patients are treated as adults. Eighty-nine of the 164 (54%) responders reported complications directly related to the use of cranial fixation pins, including cranial fracture, epidural or subdural hematoma, scalp laceration, or cerebrospinal fluid leak. One hundred fifty-four of the 164 (94%) neurosurgeons responded that they are not aware of any standard guidelines for cranial fixation pin use in pediatric patients. Seven (4%) who stated that they were aware of guidelines did not describe where they obtained those guidelines.
Conclusion:
Cranial fixation pins are widely used among pediatric neurosurgeons in patients younger than 5 years old. Guidelines for their safe use are not well defined despite common use and experience of significant complications associated with such devices.
