Background: Despite the widespread use of pin head-holder devices in neurosurgical procedures, associated complications are relatively infrequent and usually minor. Inadvertent puncture of a major scalp vessel is one of these complications. Usually it is not problematic but the injured vessel may develop a traumatic aneurysm with subsequent rupture.
Case description: We report the case of a 51-year-old man who underwent a left pterional craniotomy for intracranial aneurysm surgery. The head was fixed with the Sugita pin head-holder. Three weeks after discharge, the patient returned to the hospital after an enlarging and pulsatile mass in his left temporal region in one of the pin puncture wounds ruptured and bled. The angiogram revealed a traumatic aneurysm of the superficial temporal artery, which was ligated and excised.
Conclusion: The Sugita multipurpose head frame is one of the head-holders most frequently used in neurosurgical procedures. It provides some advantages over other pin head-holders, but its sharp point pins in addition to a rotational fixing mechanism instead of simple pressure might increase the risk of scalp vessel injury. A traumatic aneurysm should be suspected when a pulsating scalp mass develops in a patient who has recently undergone a surgical procedure with his head fixed in a pin head-holder device. Physicians must be aware of this possibility when considering the diagnosis of a temporal mass to avoid unexpected hemorrhage at the time of surgery.