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Head Fixation Devices in Neurosurgery: A Systematic Review and Meta-Analysis.

Ahmed Adnan Al-Juboori¹, Saif Anmar Badran², Aous Mohammad Qasim³

¹Department of Neurosurgery, Dr. Saad AL-Witry Hospital for Neurosciences, Baghdad, Iraq.

World Neurosurgery

|August 7, 2025

Summary

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Neurosurgical head fixation using Mayfield or Sugita systems shows rare complications, with no significant differences between them. Proper pin torque and bone quality are key to safety, not the device itself.

Area of Science:

Neurosurgery
Surgical Technology
Patient Safety

Background:

Head fixation is critical in neurosurgery, influencing precision and outcomes.
Comparing complication rates of Mayfield and Sugita fixation systems is essential.

Purpose of the Study:

To compare complication profiles between Mayfield and Sugita cranial fixation systems.
To evaluate the incidence of specific complications associated with each system.

Main Methods:

Systematic review and meta-analysis of human neurosurgical studies (PRISMA-2020 guidelines).
Searched PubMed and Scopus for studies on Mayfield or Sugita systems.
Analyzed complications including skull fracture, epidural hematoma, vascular/nerve injury, and head slippage.

Keywords:

Cranial fixation Head holder Microneurosurgery Neurosurgical ergonomics

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Main Results:

Seventeen studies with 1938 patients were included.
Overall complication rates were low (e.g., skull fracture 1.2%, epidural hematoma 1.0%).
No significant differences in complication rates were found between Mayfield and Sugita systems.

Conclusions:

Major complications are infrequent and comparable between Mayfield and Sugita clamps.
Safe head fixation depends on precise pin torque and bone quality, irrespective of device.
Torque-standardized prospective studies are recommended for further investigation.