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Soni V, Reddy A, Singh N, Chauhan R, Sarna R, Meena SC, Luthra A, Tripathi M. Comparison of the Efficacy of Sterile Silicone Studs Versus Lidocaine for the Attenuation of the Hemodynamic Response to Skull Pin Insertion: A Randomized Controlled Trial. World Neurosurg 2024:S1878-8750(24)00704-6. [PMID: 38679381 DOI: 10.1016/j.wneu.2024.04.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Skull pin insertion causes hypertension and tachycardia that adversely affects cerebral hemodynamics. We compared the efficacy of sterile silicone studs (SS) and pin site infiltration with lidocaine in attenuation of the sympathetic response to skull pin insertion. METHODS Adult patients (N = 120) undergoing supratentorial craniotomy under general anesthesia were randomized to receive either medical-grade sterile SS or 2 mL of 2% plain lidocaine infiltration at each pin site. Hemodynamic (heart rate and mean arterial pressure) response to skull pin insertion at baseline and at 0, 1, 2, 3, and 5 minutes after skull pin insertion was compared. Requirement of rescue analgesia (fentanyl), complications such as pin-site bleeding, and surgeon satisfaction score were assessed. RESULTS Heart rate in the lidocaine group was significantly greater at 0, 1, 2, 3, and 5 minutes after pin insertion compared with the SS group (P < 0.05). Mean arterial pressure was also significantly higher in the lidocaine group at 0, 1, 2, and 3 minutes after pin insertion (P = 0.001, P = 0.01, P = 0.034, and P = 0.042) compared with the SS group. The number of patients requiring fentanyl [17/60 (28.3%) vs. 40/60 (66%), P = 0.001] was lower in the SS group. The incidence of pin site bleeding was also lower in the SS group, and surgeon satisfaction score was greater. CONCLUSIONS Sterile SS appear to be more effective than lidocaine infiltration in attenuating the hemodynamic response to skull pin insertion with minimal adverse effects. Further multicenter studies are necessary to conclusively establish the safety and efficacy of sterile SS.
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Affiliation(s)
- Vishal Soni
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwini Reddy
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Singh
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rashi Sarna
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Charan Meena
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Luthra
- Department of Anesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Perez Zabala J, Basilotta Marquez Y, Argañaraz R, Mantese B. Safe First-Time use of Stereotactic Headband Fixation in a 5-Month-Old Child: An Economical and Easily Accessible Method. World Neurosurg 2024; 181:60-63. [PMID: 37844845 DOI: 10.1016/j.wneu.2023.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE We present a low-cost and easily accessible adaptation system to perform stereotactic procedures in infants. METHODS We used an adaptive device consisting of a headband with a plaster bandage, cotton bandage roll, and gauze bandages. Prior to its clinical application, the device was tested in our neuroscience laboratory using a simulation model of a size similar to that of a 5-month-old infant, during which no complications arose. The headband cast technique was subsequently reproduced in a 5-month-old patient, serving as a fixation point for the placement of a Micromar frame for biopsy of a thalamic lesion. RESULTS A stereotactic biopsy was successfully performed in a 5-month-old patient using a headband cast to secure the stereotactic frame. This method enabled precise targeting of the selected site, resulting in a histopathological diagnosis without any associated complications. CONCLUSIONS The adaptive device is safe, easily accessible, and reproducible, facilitating the performance of stereotactic diagnostic procedures in infants, accurately reaching the planned objective without causing injuries or additional complications.
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Affiliation(s)
- Joaquin Perez Zabala
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina.
| | | | - Romina Argañaraz
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina
| | - Beatriz Mantese
- Neurosurgery Department Buenos Aires, Juan P. Garrahan Hospital, Buenos Aires, Argentina
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A novel technique for frame-based MR-guided laser ablation in an infant. Childs Nerv Syst 2023; 39:497-503. [PMID: 35925382 DOI: 10.1007/s00381-022-05616-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
Abstract
Hypothalamic hamartomata (HH) not only are usually associated with drug-resistant epilepsy but can also cause precocious puberty and developmental delay. Gelastic seizures are the most common type of seizures. Magnetic resonance image (MRI)-guided laser interstitial thermal therapy (LiTT) is a technique whereby a laser fibre is stereotactically implanted into a target lesion and heat is used to ablate whilst tissue temperature is monitored using MRI thermography. MRI-guided LiTT has proven to be an effective and safe method to treat HH. To use the LiTT system, highly accurate stereotactic fibre implantation is required. This can be achieved by the use of frame-based or frameless neuronavigation techniques. However, these techniques generally involve rigid head immobilisation using cranial pin fixation. Patients need sufficient skull thickness to safely secure the pins and sufficient skull rigidity to prevent deformation. Hence, most of the clinical reports on the use of LiTT for children describe patients aged 2 years or older. We report a novel and practical technique of using a paste cast helmet to securely place a stereotactic frame in a 5-month-old infant with HH and drug-resistant epilepsy that allowed the successful application of MRI-guided LiTT.
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Thijs D, Menovsky T. The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application. World Neurosurg 2021; 151:102-109. [PMID: 33940273 DOI: 10.1016/j.wneu.2021.04.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications. METHODS PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complications clearly attributed to the Mayfield skull clamp. Both authors assessed all search results for eligibility. Additional articles were found with cross-references. RESULTS The most common complications associated with Mayfield clamp application were due to vascular injury inflicted by the pins or skull fractures. Complications related to use of the Mayfield clamp were rare but often serious and avoidable. A conceptual framework was presented on how to avoid these complications. CONCLUSIONS Attention to detail, anatomy, and the primum non nocere principle are imperative in every step of the neurosurgical pathway, including placement of the Mayfield skull clamp. Thoughtful application, taking into consideration several nuances, is recommended to avoid inadvertent patient harm.
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Affiliation(s)
- Dieter Thijs
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium.
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium
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LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr 2020; 26:98-103. [PMID: 32276245 DOI: 10.3171/2020.1.peds19541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/31/2020] [Indexed: 11/06/2022]
Abstract
Head immobilization devices with skull pins are commonly used by neurosurgeons to stabilize the head for microsurgical techniques and to maintain accurate intraoperative neuronavigation. Pediatric patients, who may have open fontanelles, unfused sutures, and thin skulls, are vulnerable to complications during placement in pins. We review the various methods of pinning in pediatric neurosurgery and revisit the modified rubber stopper technique using a commonly available rubber stopper from a medication bottle over a standard adult pin of a Mayfield head clamp to prevent the pins from plunging through the thin pediatric skull.
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Affiliation(s)
- Melissa A LoPresti
- 1Department of Neurosurgery, Baylor College of Medicine, Houston.,2Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, Texas
| | - Joshua Nguyen
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and.,4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Sandi K Lam
- 3Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago; and.,4Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
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Atteya MME, Raslan S, Elkallaf M, Soliman MS, AlQalla MA. A novel method for safe and accurate placement of the rocker pins of head immobilization devices utilizing a digital caliber phantom: technical note. Childs Nerv Syst 2019; 35:1599-1602. [PMID: 31187236 DOI: 10.1007/s00381-019-04216-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immobilization of the head and skull by head immobilization devices (HIDs) is a common practice in neurosurgery. A variety of complications and morbidities are associated with pinning the skull during application of HIDs. OBJECTIVE Our aim is to describe a new technique that avoids repeated puncturing of the head and skull during application of HIDs and hence avoiding the potential complications resulting from multiple re-adjustments. METHODS We used a pre-adjusted digital millimetric caliber (DMC) as a phantom for the two rocker pins of the HID to mimic and simulate the process of skull pinning. Localization and preparation of the accurate skull pinning sites are safely guided by the pinning phantom. RESULTS The technique was applied in different neurosurgical approaches. The pinning phantom was utilized to accurately locate the suitable pinning sites. Contrary to the common practice, there was no need for repeated head and skull puncturing. Minimal manipulations of the head and neck are exerted in this approach as compared with the usual techniques. The head of the patient is allowed to be kept safe on the operating table until the final one-time confident skull pinning by the sterilized skull clamp pins. CONCLUSION The process of scalp and skull pinning of HIDs is technically demanding. The DMC utilized as a pinning phantom is a useful technique which provides safe and confident application of the skull rocker pins of HIDs allowing the neurosurgeon to avoid multiple puncturing of scalp and skull and minimizing manipulations of the head and cervical spine.
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Affiliation(s)
- Mostafa M E Atteya
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt. .,Department of Neurosurgery, Faculty of Medicine, Children's Cancer Hospital Egypt (CCHE-57357), Cairo, Egypt.
| | - Sherif Raslan
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohamed Elkallaf
- Department of Neurosurgery, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mahmoud Salem Soliman
- Department of Critical Care and Anesthesiology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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Alexander H, Fayed I, Oluigbo CO. Rigid Cranial Fixation for Robot-Assisted Stereoelectroencephalography in Toddlers: Technical Considerations. Oper Neurosurg (Hagerstown) 2019; 18:614-620. [DOI: 10.1093/ons/opz247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/31/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Stereoelectroencephalography (sEEG) using depth electrodes has become a mainstay of pediatric epilepsy surgery. This technique relies on rigid cranial fixation using skull pins, which forms the basis for accurate stereotactic navigation. The use of cranial fixation pins poses the threat of traumatic skull injuries in young children because of inadequate cranial bone thickness.
OBJECTIVE
To describe a rigid cranial fixation technique involving the integrated Gel Head Ring from the DORO QR3 multipurpose skull clamp set (Pro Med Instruments) with superimposed pin fixation in children below the age of 36 mo undergoing sEEG.
METHODS
Patients were placed in the supine position and the head was fixed using a DORO skull clamp with 3 pediatric cranial pins. The head was supported on the integrated Gel Head Ring, and a pin pressure of 20 pounds was applied. The DORO skull clamp set was then attached to the ROSA neurosurgical robot support telescopic arm for stereotactic navigation.
RESULTS
We present an illustrative series of 2 patients below the age of 3 yr with medically refractory epilepsy who underwent sEEG using our modified cranial fixation technique. Head position and reference registration were stable throughout the surgeries. Postoperative volumetric computed tomography scans of the head showed accurate placement of sEEG depth electrodes and did not reveal any fractures or epidural hematoma. No other complications related to cranial fixation were noted.
CONCLUSION
Concurrent use of rigid and nonrigid cranial fixation using the DORO skull clamp set provides safe and effective cranial fixation in infants and toddlers undergoing sEEG.
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Affiliation(s)
- Hepzibha Alexander
- Children's National Medical Center, Department of Neurosurgery, School of Medicine, Georgetown University, Washington, District of Columbia
| | - Islam Fayed
- Children's National Medical Center, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Chima O Oluigbo
- Children's National Medical Center, Department of Neurosurgery, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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Del Rio RJ, Gonzalez RO, Jaimovich R. Method to perform safety stereotactic procedures in children under 2 years of age. Childs Nerv Syst 2018; 34:555-558. [PMID: 29063265 DOI: 10.1007/s00381-017-3624-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/13/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Stereotactic procedures have been used in neurosurgery for many years. In children especially, care should be considered to avoid complication caused by fixation of the frame in a not fully developed skull bone. We present our method to adapt the frame in children under 2 years of age. METHODS Twelve procedures in patients under 24 months were performed between 2003 and 2015. Micromar frame was used. It was adapted with a small pillow made of gauss attached to the posterior part to hold the head, then four pins were fixed without adjustment. We analyze for each patient age, indication, histopathology, and complications. RESULTS Eleven patients with a mean age of 13.5 months (range 9 to 22 months) underwent 12 stereotactic procedures. In all cases, biopsy samples were obtained, histopathology was positive in 11/12 cases. No complications occurred. CONCLUSION Stereotactic frame procedures need special attention in small children where the skull bones are not fully developed. We present a simple method to perform this surgery in patients under 2 years of age.
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Affiliation(s)
- Ramiro J Del Rio
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina.
| | - Roberto O Gonzalez
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
| | - R Jaimovich
- National Hospital of Pediatrics "Prof. Dr. Juan P. Garrahan", Combate de los Pozos 1881, C1245AAM, Buenos Aires, Argentina
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Zaazoue MA, Bedewy M, Goumnerova LC. Complications of Head Immobilization Devices in Children: Contact Mechanics, and Analysis of a Single Institutional Experience. Neurosurgery 2017; 82:678-685. [DOI: 10.1093/neuros/nyx315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 05/30/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Head immobilization devices (HIDs) are a staple of neurosurgical procedures, including in the intraoperative magnetic resonance imaging (iMRI) operating rooms (ORs) where material modifications were necessary for compatibility with the magnets utilized.
OBJECTIVE
To present the experience in this OR environment and discuss the multifactorial nature of the observed adverse events.
METHODS
A retrospective chart review was performed, utilizing the Department of Neurosurgery and iMRI OR databases to identify patients who suffered complications related to HIDs between November 2007 and March 2016. A literature review was also done to identify the magnitude of the problem and the availability of safety guidelines.
RESULTS
Nine hundred and forty patients underwent surgery in the iMRI OR requiring head immobilization. Seven (0.7%) suffered complications related to the HID—depressed skull fractures (n = 7) and epidural hematomas (n = 6). Age at surgery ranged from 1.6 to 10.3 yr. All patients had posterior fossa neoplasms and associated obstructive hydrocephalus. Four patients (57%) suffered permanent neurological deficits. Six patients (86%) underwent a surgical procedure to evacuate the epidural hematomas and repair the depressed skull fracture. In contrast, 1 out of 445 patient (0.2%) suffered HID-related adverse events in the conventional ORs, aged 10.2 yr.
CONCLUSION
HIDs are important to provide stability and support during neurosurgical procedures. Modifications in the material or the shape of the pins can significantly change the pressure exerted. Most of these complications are preventable if certain precautionary measures are taken especially in certain high-risk patients, and the overall benefits of HIDs continue to outweigh the risks. There is a need for consensus on guidelines for the safe use of these devices.
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Affiliation(s)
- Mohamed A Zaazoue
- Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mostafa Bedewy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Customizable rigid head fixation for infants: technical note. Childs Nerv Syst 2016; 32:159-61. [PMID: 26337702 DOI: 10.1007/s00381-015-2896-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/28/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The need and advantages of rigid fixation of the head in cranial surgeries are well documented (Berryhill et al., Otolaryngol Head Neck Surg 121:269-273, 1999). Head fixation for neurosurgical procedures in infants and in early years has been a challenge and is fraught with risk. Despite the fact that pediatric pins are designed, rigid head fixation involving direct application of pins to the head of infants and slightly older children is still generally not safe (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). Yet, there are some surgeries in which some form of rigid fixation is required (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). We describe a simple technique to achieve rigid fixation of the head in infants for neurosurgical procedures. TECHNICAL NOTE This involves applying a head band made of Plaster of Paris (POP) around the head and then applying the fixation pins of the fixation frame directly on to the POP. CONCLUSION We have used this technique of head fixation successfully for infants with no complications.
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Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases. Clin Neurol Neurosurg 2014; 130:42-7. [PMID: 25576884 DOI: 10.1016/j.clineuro.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. METHODS All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. RESULTS The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. CONCLUSION Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.
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Serramito-García R, Arcos-Algaba A, Santín-Amo J, García-Allut A, Bandín-Diéguez F, Gelabert-González M. Hematoma epidural secundario al empleo de cabezal autoestático en un adulto. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70139-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. Childs Nerv Syst 2008; 24:917-23; discussion 925. [PMID: 18389258 DOI: 10.1007/s00381-008-0621-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A head fixation device with pins is commonly used for immobilization of the patient's head during craniotomy. The safety of head fixation devices in children has been discussed rarely in the literature. The purpose of this report is to review our experience with complications of head fixation with pins in children undergoing craniotomies and to review the literature on this subject. MATERIALS AND METHODS The database of the Division of Neurosurgery was reviewed to identify children who had cranial complications related to the use of a pin head fixation device. The charts of these patients were reviewed retrospectively. RESULTS Five of 766 children (0.65%) undergoing craniotomies with pin fixation of the head had depressed skull fractures and/or epidural hematomas from the pin fixation. Age ranged from 2.6 to 7.5 years; all fractures were temporal and occurred during posterior fossa craniotomies. CONCLUSIONS Depressed skull fractures and associated epidural hematomas need to be considered as possible complications of pin fixation of the head for craniotomy in young children.
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Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery 2008; 62:913-8; discussion 918-9. [PMID: 18496197 DOI: 10.1227/01.neu.0000318177.95288.cb] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Cherisse Berry
- Division of Neurosurgery, Childrens Hospital Los Angeles, and Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Agrawal D, Steinbok P. Simple technique of head fixation for image-guided neurosurgery in infants. Childs Nerv Syst 2006; 22:1473-4. [PMID: 17047964 DOI: 10.1007/s00381-006-0244-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2006] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The authors describe an extremely simple technique of head fixation for image-guided neurosurgery in young children in whom standard pin fixation cannot be used. MATERIALS AND METHODS This involves positioning the head on a horseshoe headrest and using a 'U-drape' to fix the head to the headrest. RESULT Over the last 5 years, this technique of head fixation (in conjunction with Stealthstation) has been used for various neurosurgical procedures in more than ten infants successfully.
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Affiliation(s)
- Deepak Agrawal
- Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia Children's Hospital, Children's and Women's Health Centre, Vancouver, BC, Canada
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