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Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation
P Domenech-Fernandez1,2, J Yamane3, J Domenech4
1Department of Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Doctorate School, Universidad católica de Valencia san vicente martir, Av. Fernando Abril Martorell, nº 106, 46026, Valencia, C. Valenciana, España. pdomenechf@gmail.com.
Insights
Skull thickness varies significantly in children under 4 years old, requiring careful consideration for medical procedures. This study provides age-based guidelines for safe pin placement to prevent skull perforation.
Area of Science:
- Pediatric radiology
- Craniofacial anatomy
- Medical imaging analysis
Background:
- Accurate skull bone thickness measurements are crucial for pediatric neurosurgical procedures.
- Variability in skull thickness necessitates age-specific guidelines for medical device selection and placement.
Purpose of the Study:
- To establish a comprehensive reference for skull bone thickness from birth to skeletal maturity.
- To guide the selection of appropriate pin types and placement strategies based on patient age.
Main Methods:
- Computed tomography (CT) scans of 270 children and adolescents (0-17 years) were analyzed.
- Skull thickness was measured at eight distinct anatomical sites on the cranial vault.
- Statistical analysis was performed to assess age-related changes and site-specific variations.
Main Results:
- Lateral (L) skull thickness increased the least (58%) compared to anterior (A) and anterolateral (AL) sites.
- Posterior (P) and A sites showed the greatest thickness at skeletal maturity.
- Children under 4 years exhibited significant variability, with thicknesses below 3 mm in 85-92% of cases at AL and PL sites.
Conclusions:
- Pin tip length recommendations are provided: 2-3 mm for children under 4, 4 mm for ages 4-6, and 5-6 mm for older children.
- CT scans may be necessary for children under 4 due to high skull thickness variability.
- Adherence to these guidelines can reduce the risk of inner table perforation during procedures.
Purpose:
To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age.
Methods:
270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL).
Results:
From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively.
Conclusion:
We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.
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