Neurosurgery Operating Table and Skull Clamp Selection

Positions in neurosurgery and what the table must provide

Cranial approaches use supine, lateral, park-bench, prone and sometimes sitting positions, depending on the lesion. Spinal surgery is most often prone. The table must therefore offer a wide range of tilt and flex, a stable top, secure side rails for the head fixation base and enough slide for imaging. Slow, smooth, controlled movements matter, because the head is fixed and any table motion moves the patient relative to the clamp.

Agree the position sequence with the neurosurgical and anaesthetic teams before choosing equipment. The head must be positioned correctly relative to the heart, the neck must be free of excessive flexion and rotation, and access to the airway must remain possible.

Skull clamp and operating table head clamp principles

A skull clamp holds the head with pins placed at defined points. The clamp is attached to the table, either by a base unit on the side rails or by a headrest mount at the head end. The main selection criteria are rigidity, radiolucency, ease of adjustment, the range of pin holders, and compatibility with the table rail type.

Metal clamps can degrade CT and X-ray images and are unsuitable in an MRI environment. Radiolucent clamps are made from composites and keep the image clear. The mounting must hold the clamp rigidly even when the table tilts, which is why the base unit design is as important as the clamp itself.

DORO LUCENT and DORO for Spine from Black Forest Medical

The DORO LUCENT Headrest System (Cranial Stabilization System) combines the completely metal-free DORO Skull Clamp Radiolucent, a radiolucent swivel adaptor and the base unit for intraoperative CT and X-ray imaging. It has a long reach to keep the head clear for imaging, uses disposable DORO LUCENT skull pins to minimise artefacts, and its slim side parts attach to almost all OR table side-rail types. Retractor systems and navigation tracking devices mount on the Quick-Rail.

The DORO LUCENT Headrest System Pro is the flagship for iCT, X-ray and angiography. It uses a skull clamp with a patented release mechanism, a base unit without lateral overhang, plug-in pin holders and an optional pediatric kit with 2-pin holders. For spinal frames, DORO for Spine allows the head to be lowered between the rails of an open-frame table; it is metal-free and compatible with CT and angiography. See the DORO LUCENT Headrest System and DORO for Spine pages.

Table choice: Grand Promerix and imaging access

On the table side, access for imaging is key. Grand Promerix has a slim base for C-arm access, a 410 mm table top shift, a safe working load of 275 kg and a Trendelenburg range of minus 35 to plus 35 degrees, so it can serve neurosurgical lists with imaging in the same theatre. Check that the table side-rails match the base unit of your head fixation, and that the clamp can be mounted without obstructing the slide.

See our related articles on spine surgery operating tables and radiolucent tables for C-arm use.

Checklist and next steps

Before ordering, confirm side-rail compatibility, radiolucent zones, pediatric options, navigation compatibility and the disposable pins and consumables you will need. Ask about training for the theatre team on assembling and releasing the clamp in an emergency, and include the maintenance routine in your plan. View the Black Forest Medical brand page for the full DORO range, and contact Beckfinity for a demonstration or quotation.