Placement of three-pin head holders in the Concorde position.
OBJECTIVE
To reevaluate the Concorde position with different surgical interventions to the posterior fossa and cervical pathology and to improve patient comfort in the Concorde position through obtuse angle placement of the three-pin holder while the patient is in the supine position.


METHODS
Twenty-nine patients with posterior fossa pathology or cervical pathology were included in this study. All patients were operated in the Concorde position. The three-pin holder was placed with an obtuse angle while the patient was in the supine position as shown in figure 1a. The angle between the handle of the three-pin holder and the floor was measured in the supine and prone positions as shown in Figure 1A,B.


RESULTS
The average angle between the floor and the handle of the three-pin holder in the supine position and the Concorde position was 135 degrees (SD +/- 5.45) and 95 degrees (SD +/- 3.26) respectively (Figure 4) All the patient's body including the shoulders was within the borders of the operation table.


CONCLUSIONS
The placement of three-pin holders with an obtuse angle in the supine position provides three advantages: easier manipulation during neck flexion especially for cervical vertebral pathology, much less body weight loading on the three-pin holders during surgery, and less flexion of the neck to expose pathology located in the cervical or posterior fossa region.
Gulsen
Salih
S
Baskent University, School of Medicine, Neurosurgery Department, Ankara, Turkey. salihgulsen07@gmail.com
Yilmaz
Cem
C
Ozdemir
Ozgur
O
Gerilmez
Aydın
A
Caner
Hakan
H
Altinors
Nur
N
D001932:Brain Neoplasms / Q000601:surgery*; D002530:Cerebellopontine Angle / Q000601:surgery; D002574:Cervical Vertebrae / Q000293:injuries; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000601:surgery*; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D016684:Prone Position; D013116:Spinal Cord; D016103:Spinal Fractures / Q000601:surgery; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D016683:Supine Position