CC BY-NC-ND 4.0 · J Neurosci Rural Pract 2016; 07(02): 286-289
DOI: 10.4103/0976-3147.178661
Case Report
Journal of Neurosciences in Rural Practice

Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child

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
Sachinkumar Maheshbhai Patel
Department of Neurosurgery, National Neurosciences Centre, Kolkata, West Bengal, India
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)


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.

  • References

  • 1 Lee M, Rezai AR, Chou J. Depressed skull fractures in children secondary to skull clamp fixation devices. Pediatr Neurosurg 1994; 21: 174-7
  • 2 Vitali AM, Steinbok P. Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. Childs Nerv Syst 2008; 24: 917-23
  • 3 Chen TF, Yang SH, Tsai JC. Depressed skull fracture and epidural hematoma resulted from pin-type head holder for craniotomy in children. J Med Sci 2014; 34: 238-40
  • 4 Naik V, Goyal N, Agrawal D. Pin site bilateral epidural hematoma – A rare complication of using Mayfield clamp in neurosurgery. Neurol India 2011; 59: 649-51
  • 5 Sade B, Mohr G. Depressed skull fracture and epidural haematoma: An unusual post-operative complication of pin headrest in an adult. Acta Neurochir (Wien) 2005; 147: 101-3
  • 6 Lee MJ, Lin EL. The use of the three-pronged Mayfield head clamp resulting in an intracranial epidural hematoma in an adult patient. Eur Spine J 2010; 19 Suppl (Suppl. 02) S187-9
  • 7 Poli JC, Zoia C, Lattanzi D, Balbi S. Epidural haematoma by Mayfield head-holder: Case report and review of literature. J Pediatr Sci 2013; 5: e195
  • 8 Jha NK, Ebrahim S, Fallah A, Cenic A, De Villiers RA. Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium. Br J Neurosurg 2009; 23: 211-2
  • 9 Yan HJ. Epidural hematoma following use of a three-point skull clamp. J Clin Neurosci 2007; 14: 691-3
  • 10 Tang CT, Hseih CT, Chiang YH, Su YH. Epidural hematoma and depressed skull fracture resulted from pin headrest – A rare complication: Case report. Cesk Slov Neurol N 2007; 103: 584-6
  • 11 Serramito-García R, Arcos-Algaba A, Santín-Amo JM, García-Allut A, Bandín-Diéguez FJ, Gelabert-González M. Epidural haematoma due to an headrest in an adult. Neurocirugia (Astur) 2009; 20: 567-70
  • 12 Erbayraktar S, Gökmen N, Acar U. Intracranial penetrating injury associated with an intraoperative epidural haematoma caused by a spring-laden pin of a multipoise headrest. Br J Neurosurg 2001; 15: 425-8
  • 13 Won YD, Kim CH, Cheong JH, Kim JM. Skull perforation and depressed fracture following skull fixation for stereotactic surgery. Korean J Neurotrauma 2012; 8: 48-50
  • 14 Medina M, Melcarne A, Musso C, Ettorre F. Acute brain swelling during removal of supratentorial cystic lesion caused by contralateral extradural hematoma: Case report. Surg Neurol 1997; 47: 428-31
  • 15 Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery 2008; 62: 913-8