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State of the Art Cranial Ultrasound Imaging in Neonates
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Perspectives and practices in pediatric cranial fixation.

Michael M McDowell1, Amna Imran2, Benjamin E Leslie3

  • 11Department of Neurosurgery, Penn State Health Children's Hospital and Penn State College of Medicine, Hershey.

Journal of Neurosurgery. Pediatrics
|January 22, 2026
PubMed
Summary

Pediatric neurosurgeons report frequent complications with cranial fixation, including skull fractures and lacerations. They desire improved technologies for safer pediatric neurosurgery and better patient outcomes.

Keywords:
cranial fixationhead immobilizationpediatric neurosurgeryskull clampsurgical complicationssurgical technique

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Area of Science:

  • Neurosurgery
  • Pediatric Surgery
  • Medical Device Technology

Background:

  • Cranial fixation is critical for pediatric neurosurgery.
  • Complications like fractures, lacerations, and slippage are underreported in children.
  • Current study addresses pediatric neurosurgeon perspectives on skull clamping risks.

Purpose of the Study:

  • To identify pediatric neurosurgeon perspectives on skull clamping risks.
  • To understand current clamping practices and injury experiences.
  • To gauge surgeon attitudes toward injury detection and prevention systems.

Main Methods:

  • Anonymous 19-question survey distributed to 295 pediatric neurosurgeons.
  • Survey targeted surgeons registered with American Board of Pediatric Neurological Surgery and/or American Society of Pediatric Neurosurgeons.
  • Questions covered clamping practices, injury history, and technology perceptions.

Main Results:

  • 64 (21.7%) responded; 48 (16.3%) completed the survey.
  • High rates of annual complications reported: 31.5% skull fractures, 48.1% scalp lacerations, >70% clamp slippage.
  • Surgeons desire new technologies for risk mitigation (73%) and injury detection (65%).

Conclusions:

  • Significant challenges exist with pediatric cranial fixation.
  • Real-time intraoperative monitoring technologies show promise for enhancing patient safety.
  • Development of safer, more reliable cranial fixation systems is needed.