Interdisciplinary Neurosurgery · Published 2026-07-13 · DOI 10.1016/j.inat.2026.102306
Kyoichi Tomoto, Kentaro Watanabe, Hiroki Matsui, Hiroki Suetsugu, Ryoto Wachi, Nobuyuki Watanabe, Kohei Ishikawa, Akihiko Teshigawara, Michihiro Tanaka, Yuichi Murayama
Background: Skull pin fixation is essential for intraoperative head stabilization but can cause pin-site complications that impair cosmetic outcomes and quality of life. We evaluated the feasibility and safety of a pre-incision skull pin fixation (PISP) technique designed to reduce soft tissue stress at pin insertion sites. Methods: This prospective, single-center feasibility study enrolled 20 adult patients undergoing neurosurgical procedures requiring Mayfield three-point head fixation between October 2024 and March 2025. Small scalp incisions (0.5–1 cm) were made at intended pin sites prior to pin placement with standard torque. The primary outcome was secure head fixation assessed by intraoperative slippage. Secondary outcomes included depressed skull fractures and pin-site complications (ulceration, alopecia, infection) assessed at 1 week, 1 month, and 3 months postoperatively using the DESIGN-R scoring system. Results: No intraoperative head slippage or depressed skull fractures occurred. Pin-site ulceration, alopecia, and infection were not observed at any follow-up time point. Follow-up assessments were available in all patients at 1 week, 19 at 1 month, and 18 at 3 months. Conclusions: The PISP technique provided reliable head stabilization without pin-site complications in this prospective feasibility study. This simple, cost-neutral modification may reduce soft tissue–related morbidity associated with skull pin fixation. Prospective comparative studies are warranted to validate these findings.
Abstract from DOAJ. Public domain (CC0 1.0).
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Tomoto, K., Watanabe, K., Matsui, H., et al. (2026). Safety and efficacy of pre-incision skull pin fixation (PISP) technique for head stabilization. Interdisciplinary Neurosurgery. https://doi.org/10.1016/j.inat.2026.102306