Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery

Yu Deok Won; Choong Hyun Kim; Jin Hwan Cheong; Jae Min Kim

doi:10.13004/kjnt.2012.08.0.48

Journal List > Korean J Neurotrauma > v.8(1) > 1058896

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Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery

Original Article

Korean J Nutr 2012;8(1):48-50.

Published online: 19 January 2012

DOI: https://doi.org/10.13004/kjnt.2012.08.0.48

Skull Perforation and Depressed Fracture Following Skull Fixation for Stereotactic Surgery

Yu Deok Won, MD, Choong Hyun Kim, MD, PhD, Jin Hwan Cheong, MD, PhD, Jae Min Kim, MD, PhD

Department of Neurosurgery, Guri Hospital, College of Medicine, Hanyang University, Guri, Korea

Address for correspondence: Choong Hyun Kim, MD, PhD Department of Neurosurgery, Guri Hospital, College of Medicine, Hanyang University, 153 Gyeongchun-ro, Guri 471-701, Korea Tel: +82-31-560-2322, Fax: +82-31-560-2327 E-mail: kch5142@hanyang.ac.kr

Received 28 September 2011 Revised 18 December 2011 Accepted 18 December 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report an unusual case of skull perforation and depressed fracture with epidural hematoma in a 61-year-old woman who has been undertaken a skeletal fixation for stereotactic evacuation of intracerebral hematoma. Most neurosurgeons secure the patient's head in a skeletal fixation device with a three- or four-pronged pin-type headrest for stereotactic procedure or microsurgery. Although a variety of complications have been reported secondary to the use of head fixation devices, these potential complications of skull fixation have been infrequently described in the medical literatures. Consideration of calvarial thickness, tightening force, and adequate location of skull fixation may reduce the risk of skull perforation and depressed fracture.

Keywords: Complication, Depressed fracture, Epidural hematoma, Perforation, Stereotactic surgery

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FIGURE 1.

Preoperative brain computed tomography scan shows an intracerebral hematoma measuring 5.0×4.5×3.0 cm in the right temporal lobe with the small amount of perilesional edema.

FIGURE 2.

Brain computed tomography (CT) scan for calibration of reference point reveals skull perforation in two pin sites of frontal bones (A). Brain CT scan demonstrates the depressed fractures of both frontal bones and the small amount of epidural hematoma in the left frontal region (B).

FIGURE 3.

Brain computed tomography (CT) scan obtained at the 2^nd day after stereotactic procedure shows the increased amount of intracerebral hematoma (ICH) in the right temporal lobe with midline displacement (A). Postoperative CT scan demonstrates the reduction of the depressed skull in the left frontal bone and removal of ICH in the right temporal lobe (B).

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