Pneumocranium secondary to halo vest pin penetration through an enlarged frontal sinus.
We present a case report of a patient with pneumocranium secondary to halo vest pin penetration and a review of literature. The objectives of this study are to report a rare complication of halo vest pin insertion and to discuss methods of prevention of this complication. Halo vest orthosis is a commonly used and well-tolerated upper cervical spinal stabilizing device. Reports of complications related to pin penetration is rare and from our review, there has been no reports of pneumocranium occurring from insertion of pins following standard anatomical landmarks. A 57-year-old male sustained a type 1 traumatic spondylolisthesis of C2/C3 following a motor vehicle accident. During application of the halo vest, penetration of the left anterior pin through the abnormally enlarged frontal sinus occurred. The patient developed headache, vomiting and CSF rhinorrhoea over his left nostril. He was treated with intravenous Ceftriaxone for 1 week. This resulted in resolution of his symptoms as well as the pneumocranium. In conclusion, complications of halo vest pin penetration are rare and need immediate recognition. Despite the use of anatomical landmarks, pin penetration is still possible due to aberrant anatomy. All patients should have a skull X-ray with a radio-opaque marker done prior to placement of the halo vest pins and halo vest pins have to be inserted by experienced personnel to enable early detection of pin penetration.
Cheong
Min Lee
ML
Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia. cheongml1@gmail.com
Chan
Chris Yin Wei
CY
Saw
Lim Beng
LB
Kwan
Mun Keong
MK
D000063:Accidents, Traffic; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001858:Bone Nails / Q000009:adverse effects*; D002443:Ceftriaxone / Q000627:therapeutic use; D002559:Cerebrospinal Fluid Rhinorrhea / Q000188:drug therapy / Q000209:etiology*; D002574:Cervical Vertebrae / Q000293:injuries; D005626:Frontal Sinus / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013168:Spondylolisthesis / Q000601:surgery; D014143:Traction / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone