• Kazuki Sakakura, Ayataka Fujimoto, Eiichi Ishikawa, Hideo Enoki, and Tohru Okanishi.
• Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan.
• World Neurosurg. 2020 Oct 1; 142: e453-e457.

BackgroundDuring neurosurgery, we use a head clamp system for firm head fixation. However, we have encountered slippage using the head clamp system, although this has not been adequately studied. In the present study, to increase the reliability of the analysis using a more homogeneous type of patient data, we conducted a prospective study of patients who had undergone epileptic surgery. We examined the potential risk factors for head slippage and postulated that the location of the pins might be important.MethodsWe reviewed and compared the positions of the fixed head of the patients on fused preoperative and postoperative computed tomography images. We measured the distance between the corresponding head pins to determine the association with head slippage. We statistically compared the relationship between each head pin and the nasion-inion line. We also assessed age, sex, body weight, body mass index, surgical position, surgical duration, and craniotomy volume as potential risk factors for slippage.ResultsHead slippage was observed in 3 of 21 patients (14%) in the present prospective study. The most caudal head pin position was not associated with head slippage in the present study. However, the center point between the most caudal point and the most cranial point was significant (P = 0.014). A center point between the most caudal and most cranial pins from the nasion-inion line that was >6.5 cm was more likely to result in slippage.ConclusionsWe should consider that head clamp slippage could occur intraoperatively.Copyright © 2020 Elsevier Inc. All rights reserved.

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