Epidural hematoma due to Gardner-Wells Tongs placement during pediatric spinal deformity surgery
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CASE REPORT
Epidural hematoma due to Gardner‑Wells Tongs placement during pediatric spinal deformity surgery Richard Menger1 · James Lin1 · Meghan Cerpa1 · Lawrence G. Lenke1 Received: 20 November 2019 / Accepted: 6 April 2020 © Scoliosis Research Society 2020
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. Keywords Epidural hematoma · Marfan’s · Neuromonitoring · Spinal deformity
Introduction A 14-year-old male with Marfan’s Syndrome and a severe thoracic kyphoscoliosis presented for complex spinal reconstruction surgery with a three-column osteotomy via the posterior approach (Fig. 1). Gardner-Wells Tongs (GWT) was placed prior to prone positioning to provide neck stability, sagittal plane alignment, and to keep the face and eyes free during the procedure. This was done per routine without obvious incident and proper positioning directly above the * Meghan Cerpa [email protected] 1
Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, 5141 Broadway, New York, NY 10034, USA
pinna on both the left and right, with 10 lbs of cranial traction placed. Approximately 20-min into the case during exposure, intraoperative neuromonitoring (IONM) noted that the cortical left
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