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We present one case of depressed skull fractures and associated epidural hematomas resulted from pin-type head holder for craniotomy in young children.

The patient received surgical hematoma evacuation and recovered well after the surgery.

Moreover, decreasing blood hematocrit and refractory shock status developed.

Head computed tomography (CT) and magnetic resonance imaging scans revealed a posterior fossa mass [Figure 1]a with marked ventriculomegaly and the patient underwent a craniotomy for tumor resection.

The child was placed in 3-point pin fixation with the Mayfield headrest using pediatric pins tightened to a pressure of 40 lbs.

Correspondence Address: Jui Chang Tsai Department of Surgery, Division of Neurosurgery, National Taiwan University Hospital, National Taiwan University College of Medicine, No. Rd., Zhongzheng Dist., Taipei City 100, Taiwan Republic of China Source of Support: None, Conflict of Interest: None A head fixation device with pins is commonly used for immobilization of the patient's head during craniotomy.

The safety of head fixation devices in children has been discussed rarely in the literature.

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