Mayfield Pins for Occipital Brain Biopsy
Yes, Mayfield pins (skull clamps) are routinely used for occipital brain biopsies to provide rigid head fixation during the stereotactic procedure. 1, 2, 3
Standard Head Fixation Technique
The Mayfield three-pin skull clamp is the most commonly used head immobilization device in cranial neurosurgical procedures, including brain biopsies. 1
For stereotactic brain biopsies, the Mayfield head holder provides the rigid fixation necessary for accurate targeting and can be directly integrated with frameless stereotactic navigation systems. 2, 3
The standard application involves one pin placed on the single-pin side (typically frontal) and two pins on the opposite side, with a total applied force of approximately 270 N (60 lbf). 4
Technical Considerations for Occipital Approaches
When performing occipital brain biopsies, the patient is typically positioned prone with the Mayfield clamp securing the head. 5
For occipital lesions specifically, careful pin placement is critical to avoid the transverse and sigmoid sinuses, as vascular injury from pins is one of the most common serious complications. 1
The pins should be positioned to provide stable three-point fixation while avoiding:
- Major venous sinuses (transverse, sigmoid, superior sagittal)
- Thin temporal squamous bone
- Areas of skull fracture or pathology 1
Alternative Fixation Methods
Some centers use alternative head positioning systems such as specific headrests with or without pins, or other surgical head holders (e.g., Sugita holders), particularly in cadaveric laboratory settings. 5
However, for live surgical procedures requiring stereotactic accuracy—such as brain biopsies—rigid three-pin fixation with the Mayfield clamp remains the clinical standard. 2, 3
Integration with Stereotactic Systems
Modern frameless stereotactic biopsy systems are designed to attach directly to the Mayfield head holder via jointed arms or mounting brackets. 3
This integration allows for accurate trajectory planning and execution while maintaining rigid head fixation throughout the procedure. 2, 3
The diagnostic yield with Mayfield-based frameless stereotactic biopsy systems is excellent, reaching 97.4-99.7% in recent series. 2, 3
Key Safety Points
The most serious complications from Mayfield pin placement include vascular injury (particularly venous sinus penetration) and skull fractures, though these remain rare when proper technique is used. 1
Pin penetration depths vary significantly based on skull thickness and pin angle, ranging from 0 to 6.17 mm on the single-pin side. 4
Thoughtful pin placement considering local anatomy is essential to avoid inadvertent complications during occipital approaches where posterior venous structures are at risk. 1