title: Depressed skull fracture by a three-pin head holder: a case illustration.
abstract: BACKGROUND AND CASE REPORT: Many surgical procedures require a rigid immobilization of the patients' head, which is usually achieved by using a pin-type head holder. We briefly illustrate the case of a 4-year-old girl who sustained a depressed skull fracture by penetration of a pin of the head holder. The fracture was noted at the end of the surgery performed for treatment of a cerebellar astrocytoma and was managed conservatively.
  
  
  CONCLUSIONS
  Several factors seem to be involved in the production of this complication as are faulty application of the pins, excessive pin pressure, skull thinning, young patient's age, and pathological conditions that evolve with long-standing raised intracranial pressure. Prevention and management measures are briefly discussed.
authors.affiliation: Unit of Pediatric Neurosurgery, Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain. juanf.martinezlage@cablemurcia.com
authors.forename: Juan F
authors.initials: JF
authors.lastname: Martínez-Lage
authors.forename: María-José
authors.initials: MJ
authors.lastname: Almagro
authors.forename: Cristina
authors.initials: C
authors.lastname: Serrano
authors.forename: Laura
authors.initials: L
authors.lastname: Mena
mesh_terms: D001254:Astrocytoma / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D012149:Restraint, Physical / Q000009:adverse effects*; D020204:Skull Fracture, Depressed / Q000209:etiology*