- Planning Pin Sites:
- placement of skull pins in children requires preoperative CT scan of skull to assess thickness;
- pins should avoid skull suture lines, and should generally not be placed in the temporal region or into the frontal sinus;
- as in adults, avoid placing pins too far anterior (to avoid frontal sinus as well as supra-orbital nerves);
- it is recommended that 4-6 pins be inserted to finger tightness, which is about 2-5 in/lb of torque;
- Positioning:
- child should be placed on split matress which allow head to be placed in slight extension;
- Cautions:
- due to thinness of the skull, upto 40% of pediatric patients will have complications related to halo;
- halo is generally contra-indicated in patients less than 2 yrs;
- re-tightening of loose pins is associated w/ penetration of inner table of skull and subsequent brain abscess
- ref:
- Complications in children managed with immobilization in a halo vest.