Is the Mayfield Head Holder Obligatory for Intracranial Aneurysm Clipping?

• Published in: Pediatric neurosurgery Vol. 53; no. 5; p. 360
• Main Authors: Demartini, Jr, Zeferino, Gatto, Luana Antunes Maranha, da Rocha, Tatiane Coghetto, Maeda, Adriano Keijiro, Valerio, Adriana, Koppe, Gelson Luis, Francisco, Alexandre Novicki
• Format: Journal Article
• Language: English
• Published: Switzerland 01-01-2018
• Subjects: Adolescent; Aneurysm, Ruptured - complications; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - surgery; Computed Tomography Angiography; Humans; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - surgery; Male; Microsurgery - methods; Neurosurgical Procedures - methods; Patient Positioning - methods; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Surgical Instruments; Tomography, X-Ray Computed; Subarachnoid hemorrhage; Intracranial aneurysm; Middle cerebral artery; Skull clamp; Anesthesiology; Neurosurgery; Child
• ISSN: 1423-0305
• DOI: 10.1159/000491825

Intracranial aneurysm surgery is commonly performed using pinned head holders, which pose a higher risk for the pediatric population. Several authors recommend avoiding the use of this device when it is not strictly necessary, and this is currently possible considering advances in anesthesiology and monitoring. As the literature on microsurgery without skull clamp use is scant, we report the case of a 15-year-old boy presenting with a subarachnoid hemorrhage after rupture of a middle cerebral artery aneurysm. Surgical treatment was performed with the head resting on a gel cushion horseshoe; aneurysm clipping was achieved without wakefulness or awareness and the patient had a good recovery.