title: Placement of three-pin head holders in the Concorde position.
abstract: 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.
authors.affiliation: Baskent University, School of Medicine, Neurosurgery Department, Ankara, Turkey. salihgulsen07@gmail.com
authors.forename: Salih
authors.initials: S
authors.lastname: Gulsen
authors.forename: Cem
authors.initials: C
authors.lastname: Yilmaz
authors.forename: Ozgur
authors.initials: O
authors.lastname: Ozdemir
authors.forename: Aydın
authors.initials: A
authors.lastname: Gerilmez
authors.forename: Hakan
authors.initials: H
authors.lastname: Caner
authors.forename: Nur
authors.initials: N
authors.lastname: Altinors
mesh_terms: 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