The Journal of the Arkansas Medical Society Med Journal April 2020 | Page 9

system commonly utilized in neurosurgery to
stabilize the head. 3 Literature discussing the
complications from these clamps is exceptionally
rare. 2 The few complications that are documented
are quite severe, such as skull fracture, epidural
hematoma, and air embolus, with the caveat that
many lesser injuries likely go unnoticed or unre-
ported. 3,4 Patients with these complications often
have a number of comorbidities at time of pre-
sentation, which elevates the difficulty of making
an accurate diagnosis. Another factor that often
delays early diagnosis is that it is not uncommon
for patients to have post-operative fever. In this
particular patient, it was nearly four days before the
diagnosis of TM abscess was made. Ultimately, a
long course of intravenous antibiotic therapy led to
resolution of infection.
Abscess from head-securing surgical clamps is a
rare complication and requires a high level of sus-
Volume 116 • Number 10
picion, but should remain in the differential of a
febrile post-op neurosurgery patient. Best method
of diagnosis is with imaging such as CT or MRI.
Ideally, blood and abscess cultures should also
be obtained. Often, as in this case, the yield is low
given that patients are typically already on antibiotic
therapy. Head-clamp-related abscesses requires a
more aggressive antibiotic course or drainage to
resolve and could easily go overlooked in a patient
with other potential sources of infection. This is the
first reported case of temporalis muscle abscess
from such clamps.
S. Venous air embolism following application
of Mayfield head clamp: A word of caution.
Indian J Anaesth. 2018 Dec; 62(12): 1002-3.
3. Integra Neurosciences. Mayfield surgical
devices skull clamps and headrest systems.
Mayfield Surgical Devices Skull Clamps and
Headrest Systems.
4. Beuriat PA, Jacquesson T, Jouanneau E,
Berhouma M. Headholders’ – complications
in neurosurgery: a review of the literature
and recommendations for its use. 2016 Dec;
62(6): 289-94.
References
1. Cote DJ, Karhade AV, Burke WT, Larsen AM,
Smith TR. Risk factors for post-operative re-
spiratory failure among 94,621 neurosurgical
patients from 2006 to 2013: a NSQIP analysis.
Acta Neurochir. 2016 Sep; 158(9): 1639-45.
2. Khandelwal A, Gupta S, Prabhakar H, Burman
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