The Modified Concorde Position with an Intraoperative Skew Head Rotation: Technical Note

The Concorde position was developed to approach pineal and cerebellar lesions with a midline suboccipital craniotomy. The neutral head position is needed to divide the occipital muscles symmetrically. The patient’s head is tilted to the right and the face is turned to the right for the microscopic procedure to keep the midline of the patient’s head axis straight in the surgical field for comfortable and accurate surgical manipulation. However, intraoperative repositioning of the patient’s head is somewhat difficult to release the holding arm of the Sugita head holder in the original method. We found that a skew head rotation by fixing the head asymmetrically in the Sugita head holder is very quick and convenient to obtain the optimal head position both for a craniotomy and a microscopic procedure.