Head fixation devices are frequently used to immobilize the position of the head in neurosurgery. We report a rare complication of a four-pin Sugita device causing epidural hematoma (EDH) in a young adult male undergoing transcranial excision of a craniopharyngioma manifesting intraoperatively as an intractable tense brain. Decreased bone mineral density secondary to the metabolic consequences of craniopharyngioma could have increased the susceptibility to breach of the bony cortex. The index case highlights the essential role of a preoperative computed tomography (CT) scan review for the thickness of the cranial vault and the identification of weaker zones in high-risk groups.

Ashwini Reddy helped in collection of data, literature review, and manuscript preparation. Rajeev Chauhan helped in literature review, manuscript preparation, editing, and review. Shalvi Mahajan helped in manuscript preparation, editing, and review. Nidhi Panda helped in manuscript preparation, editing, and review. Sandeep Mohindra helped in data collection, manuscript preparation, editing, and review.

Article published online:
18 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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