Pin Site Epidural Hematoma Masquerading as Intractable Brain Swelling: A Diagnostic Dilemma

Abstract 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.