gms | German Medical Science

Objective: Different models of headholders are routinely used in neurosurgery to provide secure and stable positioning for surgery and better visualization of the surgical site. Moreover apart from electromagnetic navigation systems, rigid headholders are necessary for the use of intraoperative navigation. The most widely used headholder in neurosurgical practice is the Mayfield skull clamp (Ohio MedicalInstrument Co., Cincinnati, OH). Complications related to headholders are generally rare in the adult population. Here, we have systematically investigated the safety of the Mayfield skull clamp in pediatric neurosurgery.

Methods: Between 2007 and 2018, 261 children underwent a neurosurgical procedure in which the Mayfield skull clamp was used. Postoperative CT scans were performed within 24 hours. All procedures were analyzed retrospectively. Outcome was assessed by clinical examination and imaging studies on the first day after the second surgery and on follow-up 3 months postoperatively.

Results: Out of 261 patients, 3 patients (1,1%) (27 months old, female, pilocytic astrocytoma; 39-months old male, arachnoid cyst of the fourth ventricle; 14 years 8 months old male, medulloblastoma) suffered skull injury secondary resulting in an epidural hematoma to Mayfield skull clamp fixation. All three underwent surgery for hematoma removal. In two patients with chronic hydrocephalus the skull was abnormally thin. No patient had new neurological deficits due to the injury or the hematoma.

Conclusion: Complications secondary to the use of headholders could be avoided by careful study of calvarian anatomy. Upon fixation of the headholder, surgeons need to pay particular attention to the thickness of the skull and to the anatomy of the middle meningeal artery. Also, in small children shorter pins should be used.