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Mayfield Clamp

www.integralife.com_products_images_mayfield_a-1108.jpg The Mayfield Headrest and Skull Clamp System are the most common and widely used neurosurgical instruments in the world today. Designed to firmly hold a patient's head to the operating table during craniotomy drilling and delicate surgery, they are manufactured and sold by Integra LifeSciences, and they account for 90% of all headrest and skull clamp systems sold in the world.

The story began decades ago when Dr. Frank H. Mayfield went for his routine dental checkup. Dr. Mayfield was settled into a dentist’s chair, the back of his head comfortably positioned in the leather headrest, when the idea struck him. Why not develop a headrest for patients who undergo brain surgery in the operating room?

That brainstorm led Dr. Mayfield straight to his longtime colleague, George Kees, a medical illustrator with whom he had developed the Mayfield clip and clip applier.

Together, Dr. Mayfield and Mr. Kees created a new innovation: the Mayfield Horseshoe and General Purpose Headrests. The padded devices, which debuted in 1967, brought a new level of sophistication to brain surgery by cradling and stabilizing the head off the end of the operating table and allowing the surgeon better access during surgery.

For the next decade the technology reigned as the ideal way to hold the head while the surgeon opened the skull with a flexible wire saw, known as a Gigli saw. When the 1970s brought the advent of microsurgery and the use microscopes, however, changes were in store. Surgical incisions and the “field” in which surgeons operated became smaller, and the Gigli saw was replaced by tools (craniotomes) that enabled the drilling of small holes in the skull. In this arena, the Mayfield Horseshoe Headrest by itself was no longer enough to keep the head perfectly still, and it was eclipsed by a newer device – the skull clamp.

The initial invention, the Gardner skull clamp, was sound in concept but lacking in engineering finesse. Almost at once Dr. Mayfield and Mr. Keys began experimenting with a new design. They collaborated with other partners in Dr. Mayfield’s practice, and as they worked and re-worked their device they sent prototypes – and requests for feedback – to neurosurgeons all over the world.

After several design iterations, the famous Mayfield three-pin skull clamp was born.

Complications

The Mayfield clamp, often causes brief intense nociceptive stimulation, hypertension and tachycardia. Blunting this response may help prevent increased intracranial pressure, cerebral aneurysm or vascular malformation rupture, and/or myocardial stress.

A remifentanil bolus is more effective than a propofol bolus in blunting hemodynamic responses to Mayfield placement, and possibly for other short, intense nociceptive stimuli 1).

Skull fracture 2) 3)

Epidural hematoma 4). 5).

1)
Berger M, Philips-Bute B, Guercio J, Hopkins TJ, James ML, Borel CO, Warner DS, McDonagh DL. A novel application for bolus remifentanil: blunting the hemodynamic response to Mayfield skull clamp placement. Curr Med Res Opin. 2014 Feb;30(2):243-50. doi: 10.1185/03007995.2013.855190. Epub 2013 Oct 30. PubMed PMID: 24161010.
2)
Mohcine S, Brahim EM. Depressed skull fracture secondary to the Mayfield three-pin skull clamp. Pan Afr Med J. 2015 Mar 19;20:262. eCollection 2015. PubMed PMID: 26161185.
3)
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 Jul;114(6):776-8. doi: 10.1016/j.clineuro.2011.12.036. Epub 2012 Jan 18. PubMed PMID: 22261664.
4)
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 Jul;19 Suppl 2:S187-9. doi: 10.1007/s00586-010-1323-z. Epub 2010 Feb 14. PubMed PMID: 20155477; PubMed Central PMCID: PMC2899644.
5)
Yan HJ. Epidural hematoma following use of a three-point skull clamp. J Clin Neurosci. 2007 Jul;14(7):691-3. Epub 2007 Apr 25. PubMed PMID: 17462901.
mayfield_clamp.txt · Last modified: 2015/07/11 10:06 (external edit)