Traumatic aneurysm of the superficial temporal artery as a complication ofpin-type head-holder device. Case report

BACKGROUND Despite the widespread use of pin head-holder devices in neurosurgical proc edures, associated complications are relatively infrequent and usually mino r. Inadvertent puncture of a major scalp vessel is one of these complicatio ns. Usually it is not problematic but the injured vessel may develop a trau matic aneurysm with subsequent rupture. CASE DESCRIPTION We report the case of a 51-year-old man who underwent a left pterional cran iotomy for intracranial aneurysm surgery. The head was fixed with the Sugit a pin head-holder. Three weeks after discharge, the patient returned to the hospital after an enlarging and pulsatile mass in his left temporal region in one of the pin puncture wounds ruptured and bled. The angiogram reveale d a traumatic aneurysm of the superficial temporal artery, which was ligate d and excised. CONCLUSION The Sugita multipurpose head frame is one of the head-holders most frequent ly used in neurosurgical procedures. It provides some advantages over other pin head-holders, but its sharp point pins in addition to a rotational fix ing mechanism instead of simple pressure might increase the risk of scalp v essel injury. A traumatic aneurysm should be suspected when a pulsating sca lp mass develops in a patient who has recently undergone a surgical procedu re with his head fixed in a pin head-holder device. Physicians must be awar e of this possibility when considering the diagnosis of a temporal mass to avoid unexpected hemorrhage at the time of surgery. (C) 1999 by Elsevier Sc ience Inc.