title: Adaptation of skull clamp for use in image-guided surgery of children in the first 2 years of life.
abstract: BACKGROUND
  We describe a simple but effective modification of the skull clamp, aimed at stabilising the head of very young children, while avoiding the risk of creating a depressed skull fracture, in order to enable the utilisation of image-guidance in such young patients.
  
  
  METHODS
  We machined three small perspex discs 3 cm in diameter. On the outer surface of these pads we drilled reception holes for the pins to prevent slippage. To avoid direct contact with the skin, we interfaced a thick pad of soft felt. During intraoperative positioning, the weight of the head was supported by a suction bean-bag placed on the operating table. Hence, the clamp apparatus was employed only to secure the head position, and not to support the weight of the head, thus requiring less clamp force. We employed this modification in three children (aged 9, 13 and 15 months) who required image-guided surgery for brain tumours.
  
  
  RESULTS
  In all cases the head remained immobile throughout the operation, making possible the accurate use of image guidance. At the end of the operation, some transient skin redness was noticed in the contact areas, which settled in a few days.
authors.affiliation: Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. S.Sgouros@bham.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Sgouros
authors.forename: M C
authors.initials: MC
authors.lastname: Grainger
authors.forename: S
authors.initials: S
authors.lastname: McCallin
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007223:Infant; D019635:Neurosurgical Procedures / Q000379:methods*; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013525:Surgical Instruments; D016896:Treatment Outcome