Hiwatari Takaaki, Yamahata Hitoshi, Yonenaga Masanori, Fujio Shingo, Higa Nayuta, Hanaya Ryosuke, Arita Kazunori, Yoshimoto Koji
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
World Neurosurg. 2021 Nov;155:e395-e401. doi: 10.1016/j.wneu.2021.08.070. Epub 2021 Aug 20.
Pin-type head frame systems have become a worldwide standard procedure, but they can cause some complications on rare occasions. This study aimed to examine the incidence and associated risk factors of depressed skull fracture and related intracranial hematoma (DSFH) due to the use of head frames in our institute over the past 10 years.
This study included 1749 patients who underwent neurosurgical surgeries using pin-type head frames, including the Mayfield (Integra NeuroSciences, Plainsboro, NJ) skull clamp (721 cases) and the Sugita (Mizuho Ikakogyo Co., Ltd., Tokyo, Japan) head frame (1028 cases). We retrospectively reviewed hospital records of our institute to identify cases of DSFH, and documented the type of head frame used, as well as patient characteristics.
The incidence of DSFH was 0.29% (5 of 1749 cases). All 5 cases had an associated epidural hematoma, with a single case having an additional dural laceration (without subdural damage). All perforation sites, located at the parietal bone near the pterion, occurred by the unilateral horizontal screw of the Sugita head frame. None of the patients experienced postoperative neurological decline.
Even in the adult population, the DSFH by the pin-type head frame can occur infrequently. Based on our results, we recommend that the following factors should be considered when the pin-type head frame is used for neurosurgical procedures: location of pin application, thickness and fragility of the skull, and adequate control of compressive forces exerted by the head frame.
针式头架系统已成为全球标准手术方式，但在极少数情况下可能引发一些并发症。本研究旨在调查过去10年我院使用头架导致颅骨凹陷性骨折及相关颅内血肿（DSFH）的发生率及相关危险因素。
本研究纳入1749例行神经外科手术并使用针式头架的患者，包括Mayfield（Integra NeuroSciences，新泽西州普林斯顿）颅骨夹（721例）和Sugita（日本东京瑞穗医疗工业株式会社）头架（1028例）。我们回顾性查阅了我院的病历记录以确定DSFH病例，并记录所使用的头架类型以及患者特征。
DSFH的发生率为0.29%（1749例中的5例）。所有5例均伴有硬膜外血肿，其中1例还伴有硬脑膜撕裂（无硬膜下损伤）。所有穿孔部位均位于翼点附近的顶骨，均由Sugita头架的单侧水平螺钉所致。所有患者术后均未出现神经功能减退。
即使在成人中使用针式头架也可能很少发生DSFH。基于我们的研究结果，我们建议在神经外科手术中使用针式头架时应考虑以下因素：针的置入位置、颅骨的厚度和脆弱性以及对头架施加的压缩力的适当控制。
