Dear Editor,

We read with great interest the article by Barrenechea et al.[ 1 ] on the novel cranial fixation device for awake craniotomy. We agree with the authors that the older technique of pin fixation poses some problems in nonshaved patients with the difficulty to match scalp infiltration sites with final pin positions. The authors presented their flat plunger-type fixator ARTFIX (temporary fixation system) adapting to the Mayfield head holder.

We want to draw the attention toward a very simple procedure that we practice for marking pins in awake cranial surgery. In three pinhead holding systems, we place a pen in line with the pins before locally infiltrating the scalp site and the area with an “X.” We then remove the head frame, shave the small marked “X” area, and locally anesthetize it, thereby avoiding the usage of excess local anesthesia, which may produce deleterious side effects, as discussed by the authors.

We hope that this provides a simplified solution to cranial pin fixation in awake cranial surgeries.

Declaration of patient consent

Patient’s consent not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1. Barrenechea IJ, Rojas H, Nicola M, Marquez L, Herrera R, Van Isseldyk F. A novel temporary cranial fixation device for awake cranial surgery: Technical report of 14 cases. Surg Neurol Int. 2020. 11: 12-