{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:11Z","timestamp":1776096491454,"version":"3.50.1"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Cranial fixation is essential to many neurosurgical procedures for ensuring patient head immobilization and optimal surgical outcomes. However, complications such as skull fractures, scalp lacerations, and clamp slippage remain underreported and understudied in the pediatric patient population. This study aimed to identify pediatric neurosurgeon perspectives on skull clamping risks and protocols.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n An anonymous 19-question survey was distributed to 295 pediatric neurosurgeons with an email address registered with the American Board of Pediatric Neurological Surgery and\/or the American Society of Pediatric Neurosurgeons. Questions addressed clamping practices, injury experiences, perceptions of current safeguards, and attitude toward injury detection and prevention systems.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Of the 295 pediatric neurosurgeons contacted, 64 (21.7%) responded, and 48 (16.3%) completed the full survey. The median age at which respondents reported clamping pediatric skulls without additional support was 2 years, and the median minimum clamping pressure was reported to be 40 pounds. Surgeons reported substantial variability in clamping practices, particularly in minimum and maximum pressure thresholds, often citing patient-specific skull thickness as a key determinant. Injury reporting revealed that 31.5% of respondents experienced at least one skull fracture annually, 48.1% reported at least one scalp laceration annually, and annual slippage or clamp loosening was reported by > 70% of respondents. Additionally, surgeons who provided preoperative counseling regarding clamping risks were more likely to experience related risks. Overall, these surgeons expressed dissatisfaction with existing clamping technologies, citing inadequate safeguards for both injury prevention and detection. Seventy-three percent of surgeons expressed eagerness to adopt technologies capable of mitigating risks, and 65% expressed eagerness to adopt technologies capable of injury detection. These findings highlight the burden of clamp-related complications in pediatric neurosurgery and an interest in the development of safer, more reliable cranial fixation systems.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n There are substantial challenges associated with the utilization of cranial fixation in pediatric patients. Exploring real-time intraoperative monitoring technologies may offer a promising avenue for improving patient safety and surgical outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.8.peds25246","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T17:46:06Z","timestamp":1767894366000},"page":"209-219","source":"Crossref","is-referenced-by-count":0,"title":["Perspectives and practices in pediatric cranial fixation"],"prefix":"10.3171","volume":"37","author":[{"given":"Michael M.","family":"McDowell","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Penn State Health Children\u2019s Hospital and Penn State College of Medicine, Hershey;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna","family":"Imran","sequence":"additional","affiliation":[{"name":"Swanson School of Engineering, University of Pittsburgh;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin E.","family":"Leslie","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Pittsburgh;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew P.","family":"Bunger","sequence":"additional","affiliation":[{"name":"Department of Civil and Environmental Engineering, Swanson School of Engineering, University of Pittsburgh; and"},{"name":"Department of Chemical and Petroleum Engineering, Swanson School of Engineering, University of Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Clin Neurol Neurosurg","first-page":"108043","article-title":"Characterizing complications associated with skull clamps: a review of the Manufacturer and User Facility Device Experience database","volume":"235","author":"Shah HA","year":"2023","unstructured":"Shah HA, Mehta NH, Mehta SH, Ward M, McBriar JD, D\u2019Amico RS. Characterizing complications associated with skull clamps: a review of the Manufacturer and User Facility Device Experience database. Clin Neurol Neurosurg. 2023;235:108043."},{"key":"b2","article-title":"Manufacturer and User Facility Device Experience (MAUDE) database. US Food and Drug Administration","unstructured":"Manufacturer and User Facility Device Experience (MAUDE) database. US Food and Drug Administration. Accessed April 26, 2025. https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfmaude\/search.cfm"},{"issue":"1","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"98","article-title":"Pinning in pediatric neurosurgery: the modified rubber stopper technique","volume":"26","author":"LoPresti MA","year":"2020","unstructured":"LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr. 2020;26(1):98\u2013103."},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"913","article-title":"Use of cranial fixation pins in pediatric neurosurgery","volume":"62","author":"Berry C","year":"2008","unstructured":"Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery. 2008;62(4):913\u2013918."},{"issue":"5","key":"b5","series-title":"Neurosurgery","first-page":"678","article-title":"Complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience","volume":"82","author":"Zaazoue MA","year":"2018","unstructured":"Zaazoue MA, Bedewy M, Goumnerova LC. Complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience. Neurosurgery. 2018;82(5):678\u2013685."},{"key":"b6","series-title":"Proceedings of the ASME 2018 13th International Manufacturing Science and Engineering Conference (MSEC2018)","article-title":"Biomechanical root cause analysis of complications in head immobilization devices for pediatric neurosurgery","author":"Abdulhafez M","year":"2018","unstructured":"Abdulhafez M, Kadry K, Zaazoue M, Goumnerova LC, Bedewy M. Biomechanical root cause analysis of complications in head immobilization devices for pediatric neurosurgery. In: Proceedings of the ASME 2018 13th International Manufacturing Science and Engineering Conference (MSEC2018). American Society of Mechanical Engineers;2018."},{"issue":"1","key":"b7","series-title":"J Med Case Rep","first-page":"154","article-title":"Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report","volume":"15","author":"Furuya T","year":"2021","unstructured":"Furuya T, Yamazaki M, Nemoto T, Okawa A, Ohtori S. Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report. J Med Case Rep. 2021;15(1):154."},{"key":"b8","series-title":"Int J Surg Case Rep","first-page":"43","article-title":"Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature","volume":"62","author":"Parenrengi MA","year":"2019","unstructured":"Parenrengi MA, Adhiatmadja F, Arifianto MR, Apriawan T, Fauzi AA, Servadei F. Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature. Int J Surg Case Rep. 2019;62:43\u201349."},{"issue":"2","key":"b9","series-title":"J Neurosci Rural Pract","first-page":"286","article-title":"Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child","volume":"7","author":"Krishnan P","year":"2016","unstructured":"Krishnan P, Kumar SK, Kartikueyan R, Patel SM. Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract. 2016;7(2):286\u2013289."},{"key":"b10","article-title":"DORO\u00ae QR3 Multi-Purpose Skull Clamp Set","unstructured":"DORO\u00ae QR3 Multi-Purpose Skull Clamp Set. Black Forest Medical Group. Accessed April 26, 2025. https:\/\/www.blackforestmedical.com\/products\/cranial-stabilization\/skull-clamps\/doro-qr3-multi-purpose-skull-clamp-set"},{"key":"b11","series-title":"World Neurosurg","first-page":"e395","article-title":"The incidence of depressed skull fractures due to the use of pin-type head frame systems in the adult population: 10-year experience of a single neurosurgical center","volume":"155","author":"Hiwatari T","year":"2021","unstructured":"Hiwatari T, Yamahata H, Yonenaga M, The incidence of depressed skull fractures due to the use of pin-type head frame systems in the adult population: 10-year experience of a single neurosurgical center. World Neurosurg. 2021;155:e395\u2013e401."},{"issue":"6","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"649","article-title":"Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time","volume":"34","author":"Muzyka L","year":"2024","unstructured":"Muzyka L, Pugazenthi S, Kann MR, Strahle JM. Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time. J Neurosurg Pediatr. 2024;34(6):649\u2013658."},{"key":"b1","series-title":"Clin Neurol Neurosurg","first-page":"108043","article-title":"Characterizing complications associated with skull clamps: a review of the Manufacturer and User Facility Device Experience database","volume":"235","author":"Shah HA","year":"2023","unstructured":"Shah HA, Mehta NH, Mehta SH, Ward M, McBriar JD, D\u2019Amico RS. Characterizing complications associated with skull clamps: a review of the Manufacturer and User Facility Device Experience database. Clin Neurol Neurosurg. 2023;235:108043."},{"key":"b2","article-title":"Manufacturer and User Facility Device Experience (MAUDE) database. US Food and Drug Administration","unstructured":"Manufacturer and User Facility Device Experience (MAUDE) database. US Food and Drug Administration. Accessed April 26, 2025. https:\/\/www.accessdata.fda.gov\/scripts\/cdrh\/cfdocs\/cfmaude\/search.cfm"},{"issue":"1","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"98","article-title":"Pinning in pediatric neurosurgery: the modified rubber stopper technique","volume":"26","author":"LoPresti MA","year":"2020","unstructured":"LoPresti MA, Nguyen J, Lam SK. Pinning in pediatric neurosurgery: the modified rubber stopper technique. J Neurosurg Pediatr. 2020;26(1):98\u2013103."},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"913","article-title":"Use of cranial fixation pins in pediatric neurosurgery","volume":"62","author":"Berry C","year":"2008","unstructured":"Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG. Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery. 2008;62(4):913\u2013918."},{"issue":"5","key":"b5","series-title":"Neurosurgery","first-page":"678","article-title":"Complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience","volume":"82","author":"Zaazoue MA","year":"2018","unstructured":"Zaazoue MA, Bedewy M, Goumnerova LC. Complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience. Neurosurgery. 2018;82(5):678\u2013685."},{"key":"b6","series-title":"Proceedings of the ASME 2018 13th International Manufacturing Science and Engineering Conference (MSEC2018)","article-title":"Biomechanical root cause analysis of complications in head immobilization devices for pediatric neurosurgery","author":"Abdulhafez M","year":"2018","unstructured":"Abdulhafez M, Kadry K, Zaazoue M, Goumnerova LC, Bedewy M. Biomechanical root cause analysis of complications in head immobilization devices for pediatric neurosurgery. In: Proceedings of the ASME 2018 13th International Manufacturing Science and Engineering Conference (MSEC2018). American Society of Mechanical Engineers;2018."},{"issue":"1","key":"b7","series-title":"J Med Case Rep","first-page":"154","article-title":"Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report","volume":"15","author":"Furuya T","year":"2021","unstructured":"Furuya T, Yamazaki M, Nemoto T, Okawa A, Ohtori S. Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report. J Med Case Rep. 2021;15(1):154."},{"key":"b8","series-title":"Int J Surg Case Rep","first-page":"43","article-title":"Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature","volume":"62","author":"Parenrengi MA","year":"2019","unstructured":"Parenrengi MA, Adhiatmadja F, Arifianto MR, Apriawan T, Fauzi AA, Servadei F. Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature. Int J Surg Case Rep. 2019;62:43\u201349."},{"issue":"2","key":"b9","series-title":"J Neurosci Rural Pract","first-page":"286","article-title":"Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child","volume":"7","author":"Krishnan P","year":"2016","unstructured":"Krishnan P, Kumar SK, Kartikueyan R, Patel SM. Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract. 2016;7(2):286\u2013289."},{"key":"b10","article-title":"DORO\u00ae QR3 Multi-Purpose Skull Clamp Set","unstructured":"DORO\u00ae QR3 Multi-Purpose Skull Clamp Set. Black Forest Medical Group. Accessed April 26, 2025. https:\/\/www.blackforestmedical.com\/products\/cranial-stabilization\/skull-clamps\/doro-qr3-multi-purpose-skull-clamp-set"},{"key":"b11","series-title":"World Neurosurg","first-page":"e395","article-title":"The incidence of depressed skull fractures due to the use of pin-type head frame systems in the adult population: 10-year experience of a single neurosurgical center","volume":"155","author":"Hiwatari T","year":"2021","unstructured":"Hiwatari T, Yamahata H, Yonenaga M, The incidence of depressed skull fractures due to the use of pin-type head frame systems in the adult population: 10-year experience of a single neurosurgical center. World Neurosurg. 2021;155:e395\u2013e401."},{"issue":"6","key":"b12","series-title":"J Neurosurg Pediatr","first-page":"649","article-title":"Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time","volume":"34","author":"Muzyka L","year":"2024","unstructured":"Muzyka L, Pugazenthi S, Kann MR, Strahle JM. Mapping the landscape of pediatric neurosurgery: geography, gender, and trends over time. J Neurosurg Pediatr. 2024;34(6):649\u2013658."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/3\/article-p209.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/3\/article-p209.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/3\/article-p209.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:20Z","timestamp":1776094040000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/3\/article-p209.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":24,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2025.8.peds25246","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]}}}