Herein, we describe a case of epidural hematoma associated with the use of a Mayfield head clamp. An 18-year old patient with an upper brainstem tumour causing obstructive hydrocephalus underwent a routine third ventriculostomy, which unexpectedly revealed an intracranial hemorrhage. We outline potential risk factors, propose an algorithm for preventing complications associated with the use of pin-type fixation, and conducted a structured review of the literature to identify similar clinical scenarios.

Department of Neurosurgery Faculty of Medicine Masaryk University Brno Czech Republic

Department of Neurosurgery University Hospital Brno Brno Czech Republic

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Baerts WD, de Lange JJ, Booij LH, Broere G. Complications of the Mayfield skull clamp. Anesthesiology. 1984;61:460–461. PubMed

Beuriat PA, Jacquesson T, Jouanneau E, Berhouma M. Headholders’ - complications in neurosurgery: a review of the literature and recommendations for its use. Neurochirurgie. 2016;62:289–294. PubMed

Bindra A, Rath GP, Chowdhury T, Mishra P. Epidural hematoma at skull pin fixation sites may cause refractory intraoperative brain bulge. J Clin Anesth. 2012;24:509–510. PubMed

Erbayraktar S, Gökmen N, Acar U. Intracranial penetrating injury associated with an intraoperative epidural haematoma caused by a spring-laden pin of a multipoise headrest. Br J Neurosurg. 2001;15:425–428. PubMed

Fernández-Portales I, Cabezudo JM, Lorenzana L, Gómez L, Porras L, Rodríguez JA. Traumatic aneurysm of the superficial temporal artery as a complication of pin-type head-holder device. Case report. Surg Neurol. 1999;52:400–403. PubMed

Furuya T, Yamazaki M, Nemoto T, Okawa A, Ohtori S. Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report. J Med Case Reports. 2021;15:154. PubMed PMC

Hiwatari T, Yamahata H, Yonenaga M, Fujio S, Higa N, Hanaya R, et al. The incidence of depressed skull fractures due to the use of pin-type head frame systems in the adult population: 10-year experience of a single neurosurgical center. World Neurosurg. 2021;155:e395–e401. PubMed

Inagawa T, Takeda T, Taguchi H, Kamiya K, Yamada T. Traumatic middle meningeal arteriovenous fistula caused by three-point skull fixation. Case report. J Neurosurg. 1984;60:853–855. PubMed

Integra LifeSciences Corporation. MAYFIELD Infinity XR2 Skull Clamp (A2114) Instruction Manual. Princeton, NJ: Integra LifeSciences Corporation; 2009. [Accessed September 6, 2023]. https://www.cardion.cz/file/1238/mayfield-xr2-brochure.pdf .

Jetté N, Lix LM, Metge CJ, Prior HJ, McChesney J, Leslie WD. Association of antiepileptic drugs with nontraumatic fractures: a population-based analysis. Arch Neurol. 2011;68:107–112. PubMed

Jha NK, Ebrahim S, Fallah A, Cenic A, De Villiers RA. Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium. Br J Neurosurg. 2009;23:211–212. PubMed

Khandelwal A, Gupta S, Prabhakar H, Burman S. Venous air embolism following application of Mayfield head clamp: a word of caution. Indian J Anaesth. 2018;62:1002–1003. PubMed PMC

Krishnan P, Kumar SK, Kartikueyan R, Patel SM. Pin-site epidural hematoma: a catastrophic complication of cranial fixation in a child. J Neurosci Rural Pract. 2016;7:286–289. PubMed PMC

Lee MJ, Lin EL. The use of the three-pronged Mayfield head clamp resulting in an intracranial epidural hematoma in an adult patient. Eur Spine J. 2010;19(Suppl 2):S187–S189. PubMed PMC

Lundgren M, Elfallal W, Park D. Acute postoperative unilateral frontalis palsy with spontaneous resolution after placement of Mayfield skull clamp. J Am Acad Orthop Surg Glob Res Rev. 2020;4:00123–00125. PubMed PMC

Matouk CC, Ellis MJ, Kalia SK, Ginsberg HJ. Skull fracture secondary to application of a Mayfield skull clamp in an adult patient: case report and review of the literature. Clin Neurol Neurosurg. 2012;114:776–778. PubMed

Naik V, Goyal N, Agrawal D. Pin site bilateral epidural hematoma - a rare complication of using Mayfield clamp in neurosurgery. Neurol India. 2011;59:649–651. PubMed

Parenrengi MA, Adhiatmadja F, Arifianto MR, Apriawan T, Fauzi AA, Servadei F. Bilateral skull fracture with massive epidural hematoma secondary to pin-type head fixation in a pediatric patient: case report and review of the literature. Int J Surg Case Rep. 2019;62:43–49. PubMed PMC

Prabhakar H, Ali Z, Bhagat H. Venous air embolism arising after removal of Mayfield skull clamp. J Neurosurg Anesthesiol. 2008;20:158–159. PubMed

Sade B, Mohr G. Depressed skull fracture and epidural haematoma: an unusual post-operative complication of pin headrest in an adult. Acta Neurochir (Wien) 2005;147:101–103. PubMed

Serramito-García R, Arcos-Algaba A, Santín-Amo JM, García-Allut A, Bandín-Diéguez FJ, Gelabert-González M. Epidural haematoma due to an headrest in an adult. Neurocirugia (Astur) 2009;20:567–570. PubMed

Taira T, Tanikawa T. Breakage of Mayfield head rest. J Neurosurg. 1992;77:160–161. PubMed

Thijs D, Menovsky T. The Mayfield skull clamp: a literaturereview of its complications and technical nuances for application. World Neurosurg. 2021;151:102–109. PubMed

Tyagi G, Bhat DI, Devi BI, Shukla D. Multiple remote sequential supratentorial epidural hematomas-an unusual and rare complication after posterior fossa surgery. World Neurosurg. 2019;128:83–90. PubMed

Vitali AM, Steinbok P. Depressed skull fracture and epidural hematoma from head fixation with pins for craniotomy in children. Childs Nerv Syst. 2008;24:917–923. PubMed

Wang BY, Wu TK, Liu H, Hong Y, Meng Y. In vitro stability analysis of the three-pronged Mayfield head clamp using pins in four different positions on the skulls. Int J Clin Exp Med. 2018;11:5736–5742.

Yan HJ. Epidural hematoma following use of a three-point skull clamp. J Clin Neurosci. 2007;14:691–693. PubMed