A novel method for safe and accurate placement of the rocker pins of head immobilization devices utilizing a digital caliber phantom: technical note

  • Mostafa M. E. AtteyaEmail author
  • Sherif Raslan
  • Mohamed Elkallaf
  • Mahmoud Salem Soliman
  • Muhammad Abbas AlQalla
Technical Notes



Immobilization of the head and skull by head immobilization devices (HIDs) is a common practice in neurosurgery. A variety of complications and morbidities are associated with pinning the skull during application of HIDs.


Our aim is to describe a new technique that avoids repeated puncturing of the head and skull during application of HIDs and hence avoiding the potential complications resulting from multiple re-adjustments.


We used a pre-adjusted digital millimetric caliber (DMC) as a phantom for the two rocker pins of the HID to mimic and simulate the process of skull pinning. Localization and preparation of the accurate skull pinning sites are safely guided by the pinning phantom.


The technique was applied in different neurosurgical approaches. The pinning phantom was utilized to accurately locate the suitable pinning sites. Contrary to the common practice, there was no need for repeated head and skull puncturing. Minimal manipulations of the head and neck are exerted in this approach as compared with the usual techniques. The head of the patient is allowed to be kept safe on the operating table until the final one-time confident skull pinning by the sterilized skull clamp pins.


The process of scalp and skull pinning of HIDs is technically demanding. The DMC utilized as a pinning phantom is a useful technique which provides safe and confident application of the skull rocker pins of HIDs allowing the neurosurgeon to avoid multiple puncturing of scalp and skull and minimizing manipulations of the head and cervical spine.


Head immobilization devices Skull clamp Mayfield holder Skull pinning Head clamp 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest in personal, financial, institutional or industry affiliations in any of the drugs, materials, or devices described in this article. The authors have no conflicts that may affect ethical adherence.


  1. 1.
    Lee M, Rezai AR, Chou J (1994) Depressed skull fractures in children secondary to skull clamp fixation devices. Pediatr Neurosurg 21(3):174–177 discussion 178CrossRefGoogle Scholar
  2. 2.
    Berry C, Sandberg DI, Hoh DJ, Krieger MD, McComb JG (2008) Use of cranial fixation pins in pediatric neurosurgery. Neurosurgery. 62(4):913–918; discussion 918-9. CrossRefGoogle Scholar
  3. 3.
    Matouk CC, Ellis MJ, Kalia SK, Ginsberg HJ (2012) Skull fracture secondary to application of a Mayfield skull clamp in an adult patient: case report and review of the literature. Clin Neurol Neurosurg 114(6):776–778. CrossRefGoogle Scholar
  4. 4.
    Zaazoue MA, Bedewy M, Goumnerova LC (2018) Complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience. Neurosurgery 82(5):678–685. CrossRefGoogle Scholar
  5. 5.
    Lee TH, Kim SJ, Cho DS (2009) Broken Mayfield head clamp. J Korean Neurosurg Soc 45(5):306–308. CrossRefGoogle Scholar
  6. 6.
    Manabe N, Shimizu T, Tanouchi T, Fueki K, Ino M, Toda N, Itoh K, Shirakura K (2015) A novel skull clamp positioning system and technique for posterior cervical surgery: clinical impact on cervical sagittal alignment. Medicine (Baltimore) 94(17):e695. CrossRefGoogle Scholar
  7. 7.
    Baerts WD, de Lange JJ, Booij LH, Broere G (1984) Complications of the Mayfield skull clamp. Anesthesiology. 61(4):460–461CrossRefGoogle Scholar
  8. 8.
    Anegawa S, Shigemori M, Yoshida M, Kojo N, Torigoe R, Shirouzu T, Kuramoto S (1986) Postoperative tension pneumocephalus--report of 3 cases. No Shinkei Geka 14(8):1017–1022Google Scholar
  9. 9.
    Serramito-Garcı’a R, Arcos-Algaba A, Santı’n-Amo JM, Garcı’a-Allut A, Bandı’n-Die’guez FJ, Gelabert-Gonza’lez M (2009) Epidural hematoma due to an headrest in an adult. Neurocirugia (Astur) 20(6):567–570CrossRefGoogle Scholar
  10. 10.
    Sade B, Mohr G (2005) Depressed skull fracture and epidural haematoma: an unusual post-operative complication of pin headrest in an adult. Acta Neurochir 147(1):101–103CrossRefGoogle Scholar
  11. 11.
    Grinberg F, Slaughter TF, McGrath BJ (1995) Probable venous air embolism associated with removal of the Mayfield skull clamp. Anesth Analg 80(5):1049–1050Google Scholar
  12. 12.
    Miyoshi H, Nakamura R, Hamada H (2015) Asystole following skull clamp to Chiari malformation. J Anesth 29(2):317. CrossRefGoogle Scholar
  13. 13.
    Sadideen H, Saadeddin M, Whitwell D, Giele H (2012) Forehead pressure sore following a prolonged operation and the role of the Mayfield head frame in re-operation. J Anesth 26(3):473–474. CrossRefGoogle Scholar
  14. 14.
    U.S. Food and Drug Administration (2016) Neurosurgical head holders (skull clamps) and device slippage: FDA safety communication. URL:, Accessed 11-03-2019
  15. 15.
    Gupta N (2006) A modification of the Mayfield horseshoe headrest allowing pin fixation and cranial immobilization in infants and young children. Neurosurgery. 58(1 Suppl):ONS-E181 discussion ONS-E181Google Scholar
  16. 16.
    Sgouros S, Grainger MC, McCallin S (2005) Adaptation of skull clamp for use in image-guided surgery of children in the first 2 years of life. Childs Nerv Syst 21(2):148–149CrossRefGoogle Scholar
  17. 17.
    Rhea AH, Tranmer BI, Gross CE (1986) Intraoperative cervical spine stabilization using the halo ring and the Mayfield three-pin skull clamp. Technical note. J Neurosurg 64(1):157–158CrossRefGoogle Scholar
  18. 18.
    Atteya MME, Raslan S, Soliman MS, Elkallaf M (2019) Letter: complications of head immobilization devices in children: contact mechanics, and analysis of a single institutional experience. Neurosurgery. 84(1):E95. CrossRefGoogle Scholar
  19. 19.
    Johnson KL (1985) Contact mechanics. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  20. 20.
    Kerwin GA, Chou KL, White DB, Shen KL, Salciccioli GG, Yang KH (1994) Investigation of how different halos influence pin forces. Spine (Phila Pa 1976) 19(9):1078–1081CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mostafa M. E. Atteya
    • 1
    • 2
    Email author
  • Sherif Raslan
    • 1
  • Mohamed Elkallaf
    • 1
  • Mahmoud Salem Soliman
    • 3
  • Muhammad Abbas AlQalla
    • 1
  1. 1.Department of Neurosurgery, Faculty of MedicineHelwan UniversityHelwanEgypt
  2. 2.Department of Neurosurgery, Faculty of MedicineChildren’s Cancer Hospital Egypt (CCHE-57357)CairoEgypt
  3. 3.Department of Critical Care and Anesthesiology, Kasr Al Ainy School of MedicineCairo UniversityCairoEgypt

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