Depressed skull fracture and extradural hematoma are infrequent complications of skull
pin fixation in children undergoing craniotomy. Neurosurgeons are often alerted about
these complications by intraoperative brain swelling or postoperative neurological
deterioration. We describe the development of pin-site extradural hematoma in a child
on whom Mayfield skull clamp was applied during posterior fossa tumor excision. Sudden
and persistent bradycardia observed by the anesthesiologist served as the sole warning
sign. Such an on-table indicator of pin-site extradural hematoma has not been described
earlier. The anesthesiologist must maintain vigilance and effective communication
with surgical colleagues to ensure early detection and timely management of these
pin-site complications.
Keywords
bradycardia - cranial fixation - depressed skull fracture - extradural hematoma -
pediatric - pin-site complications - posterior fossa
