The Mayfield Skull Clamp: A Literature Review of Its Complications and Technical Nuances for Application.

Abstract

The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications. PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complications clearly attributed to the Mayfield skull clamp. Both authors assessed all search results for eligibility. Additional articles were found with cross-references. The most common complications associated with Mayfield clamp application were due to vascular injury inflicted by the pins or skull fractures. Complications related to use of the Mayfield clamp were rare but often serious and avoidable. A conceptual framework was presented on how to avoid these complications. Attention to detail, anatomy, and the primum non nocere principle are imperative in every step of the neurosurgical pathway, including placement of the Mayfield skull clamp. Thoughtful application, taking into consideration several nuances, is recommended to avoid inadvertent patient harm.