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Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child
Prasad Krishnan1, Soumen Kanti Kumar1, Rajaraman Kartikueyan1
1Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India.
Insights
Skull fractures at pin sites are a rare neurosurgery complication. This case highlights intraoperative detection of a skull fracture and epidural hematoma during pediatric posterior fossa tumor surgery.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Surgical Complications
Background:
- Cranial fixation with pins is a standard neurosurgical procedure.
- While generally safe, pin site complications can occur.
- Skull fracture and epidural hematoma are rare but serious risks.
Observation:
- A 12-year-old child with a posterior fossa tumor experienced an intraoperative complication.
- An unexplained "brain bulge" suggested an issue at the pin site.
- The surgical team identified a skull fracture and resulting epidural hematoma.
Findings:
- The complication was identified intraoperatively, allowing for immediate intervention.
- This contrasts with typical postoperative diagnosis of such events.
- The case involved a pediatric patient undergoing complex posterior fossa surgery.
Implications:
- Highlights the importance of recognizing subtle intraoperative signs of pin site complications.
- Emphasizes the need for prompt termination of surgery and urgent imaging if complications are suspected.
- Contributes to the literature on rare neurosurgical complications and their management.
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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