Abstract
Background
To our knowledge, this is the first documented report of an operative cranial epidural hematoma secondary to skull fracture due to placement of Gardner-Wells Tongs (GWT) in the setting of a spinal deformity reconstruction.
Purpose
The objective is to illustrate the possibility of cranial pathology secondary to GWT placement and the need to properly correlate intraoperative neuromonitoring findings.
Study design
Case report.
Methods
A 14-year-old male with Marfan’s Syndrome presented for three-column osteotomy spinal reconstruction for a large and stiff thoracic kyphoscoliosis. Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability without issue. During the lumbar posterior column osteotomies the patient began to lose upper and lower extremity motor data. This indicated a cranial pathology. A temporary rod was placed on the concavity and an emergent flip without closure was performed. Upon flip, the patient was fixed and dilated with only right corneal reflex. The patient was rushed to the CT scanner where a large right-sided epidural hematoma was noted with a temporal bone fracture at the pin site, with the patient’s right temporal bone noted to be only 1.3 mm in thickness.
Results
The patient underwent emergent epidural hematoma evacuation by the Neurosurgical team. The patient was discharged to rehabilitation 1 week after his cranial epidural hematoma surgery with a complete recovery including with full strength examination of all extremities. He subsequently underwent a definitive posterior spinal fusion with posterior column osteotomies 8 weeks later.
Conclusion
Cranial pin fixation has the rare possibility to produce cranial pathology and has a specific complication protocol. Proper utilization and interpretation of neuromonitoring is essential to aid in intraoperative decision-making.
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RM: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published, contributed effort to the study. MC: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work, drafting the work and revising it critically for important intellectual content, final approval of the version to be published, contributed effort to the study. JL: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work, revising the work critically for important intellectual content, final approval of the version to be published, contributed effort to the study. LGL: substantial contributions to the conception and design of the work, revising the work critically for important intellectual content, final approval of the version to be published, contributed cases and effort to the study.
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This study was approved by the Institutional Review Board of Columbia University (protocol # AAAR1866).
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Menger, R., Lin, J., Cerpa, M. et al. Epidural hematoma due to Gardner-Wells Tongs placement during pediatric spinal deformity surgery. Spine Deform 8, 1139–1142 (2020). https://doi.org/10.1007/s43390-020-00116-2
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DOI: https://doi.org/10.1007/s43390-020-00116-2