Skull Clamp Types in Neurosurgery and How They Differ

Invasive pin-based skull clamps

The classic type is the three-pin clamp, often called a Mayfield 3 pin head holder after the original design. Two pins sit on one arm and one on the other, forming a stable triangle against the skull. It gives rigid fixation for craniotomy, skull-base surgery and some upper cervical procedures, and it provides a platform for navigation and retractors. See the Mayfield head holder explained.

Some designs use four pins, two per arm, and paediatric holders may use two pins. The number of pins is a feature of the clamp design and the way force is spread; there is no single best layout, and the surgeon's preference and the manufacturer's instructions for use apply.

When evaluating a pin-based clamp, ask how the lock and quick-release mechanism work, because the team must be able to free the head fast in an emergency.

Metal and radiolucent skull clamps

Material is the next dividing line. Aluminium clamps are robust and suit everyday non-imaging surgery. Radiolucent clamps use metal-free materials such as carbon-fibre composites so that the clamp does not cause artefacts in intraoperative CT, X-ray or angiography. MRI needs designs and interfaces made for the MR environment.

The DORO LUCENT Headrest System from Black Forest Medical combines a completely metal-free skull clamp, a radiolucent swivel adaptor and a base unit for intraoperative CT and X-ray. It has a long reach so that the head sits clear in the gantry. See DORO LUCENT Headrest System and our guide to radiolucent headrest systems.

Invasive, non-invasive and combined fixation

Not every case needs pins. A horseshoe headrest supports the head on shape-taking gel pads, and some clamps allow a mix of pins and pads. The DORO Horseshoes offer standard, radiolucent, carbon-tabletop and ENT versions, with adult and pediatric pads on the same base, while the DORO Multi-Purpose skull clamp allows non-invasive, invasive or combined fixation for patients from newborns to seniors.

Non-invasive supports are less rigid and are mainly chosen where a lower stability requirement and avoiding pin sites outweigh the need for absolute fixation. See DORO Horseshoes.

• Pin-based clamp: rigid fixation, navigation platform
• Horseshoe headrest: gel pads, no pin sites, adjustable
• Combined: pins plus pads for selected cases
• Pediatric options: dedicated holders and pads

Choosing between skull clamp types

Start from your cases and imaging: do you operate on children, do you plan intraoperative CT or MRI, how often do you use navigation, which tables do you have? Then map the answers to a short list of systems. A clamp that supports Mix & Match of aluminium and radiolucent components can reduce the number of separate systems you need.

Our head fixation system buying guide adds practical checks, and the article on skull clamp safety and complications explains risks to discuss with your clinical team.

A small department may start with one universal clamp that covers most adult and pediatric cases, then add specialised radiolucent components when imaging is introduced.

Sourcing head fixation devices in the UAE

Confirm that the product is registered for use in the UAE, ask for the instructions for use, pin supply details and cleaning guidance, and check table compatibility before ordering.

Beckfinity supplies Black Forest Medical DORO head fixation to hospitals in the UAE. To compare options for your theatre or request a quote, contact our specialists.