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Skull Clamp Placement

Last Updated: September 27, 2018

Figure 1: A patient of Harvey Cushing’s is shown positioned on the operating room table to undergo resection of her acoustic neuroma. Note the anesthesia machine and the note pad used for recording anesthesia details (circa ~1930)(Photo courtesy of the Cushing Brain Tumor Registry at Yale University.)

The discussion in this chapter describes the correct application of the Mayfield® three-point skull stabilization and fixation device (Integra LifeSciences, Plainsboro, NJ) primarily during craniotomy procedures. This device has stood the test of time and its sophistication relies on its simplicity.

The initial step in skull fixation involves firm application of the two-point arm to the patient’s cranium before applying pressure with the contralateral single pin. When considering clamp placement, the surgeon must be mindful of the anatomy of the patient’s head to avoid pin...