What Is a Mayfield Head Holder in Neurosurgery?

What is a Mayfield head holder and why is it used?

In neurosurgery even small head movement can matter, and a Mayfield-type holder removes that variable. Two pins on one side and one on the other press into the outer skull surface, so the head is locked in a fixed position and connected through a base to the OR table. This is the basis of Mayfield 3 point head fixation.

Fixation also makes image-guided navigation reliable, because a tracking reference can be mounted on the clamp and the registration is not lost when the table is tilted. Typical uses are craniotomy, skull-base work, posterior fossa approaches and some upper cervical spine procedures. For the full procedure flow see our article on craniotomy steps and equipment.

Mayfield skull clamp parts

A complete system is more than the clamp itself. The usual building blocks are the skull clamp with its pin holders, a swivel adaptor that lets the clamp rotate and lock at the desired angle, and a base unit that attaches to the table side rail or to a table adaptor. Pins are single-use or reusable depending on the system.

On the DORO QR3 from Black Forest Medical, for example, the set consists of the QR3 skull clamp, a swivel adaptor and an adjustable base unit, and the clamp has a Quick-Rail for retractor arms and starburst interfaces for navigation adaptors. The DORO QR3 is intended for non-imaging procedures and offers extra height for intubation, including in the prone position.

• Skull clamp with adult pin holders (and pediatric holders where offered)
• Swivel adaptor for angle adjustment and locking
• Base unit with table rail or adaptor mounting
• Mayfield headrest with pins or gel pads for non-invasive support
• Accessories: retractor arm interface, navigation adaptor, torque screw

Pins, pads and non-invasive options

Not every patient needs pins. Infants and very thin skulls call for different strategies, and many procedures only need support rather than rigid fixation. The DORO Multi-Purpose skull clamp is designed for patients from newborns to seniors and allows a non-invasive set-up on gel pads, rigid pin fixation, or a non-invasive headrest combined with pins.

It comes with adult and pediatric pin holders, gel head and ear rings and an adjustable trio gel pad, and an optional 90 N torque screw gives finer control of lower pin forces. Pin force settings must always follow the manufacturer's instructions for use and the surgeon's decision. For placement technique read pin placement for a 3-pin clamp.

Metal or radiolucent: matching the clamp to the OR

A metal clamp is fine for conventional cases, but if the OR uses intraoperative CT, X-ray or MRI, the clamp and base should not create artefacts in the image. Radiolucent systems use metal-free materials and low-artefact pins for this reason. Check which imaging modality is installed, the gantry opening and the table rail type before choosing.

Compatibility with your OR table is the most common stumbling block. Ask the supplier to confirm the rail geometry, any required adaptors and whether components from different product lines can be combined. Our guide to skull clamp types compares the main variants side by side.

Buying a Mayfield-type head holder in the UAE

Beyond the clamp, ask about pin supply, cleaning and sterilisation instructions, spare parts and staff training. Devices must be registered with the relevant UAE authority, and facility requirements differ by emirate, so confirm current rules before ordering.

Beckfinity supplies Black Forest Medical DORO systems to hospitals in the UAE. To compare configurations for your neurosurgery theatre or request a quote, speak to our specialists through the contact page.