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Flexion of the head with obliteration of the folds usually found in the occipital and cervical regions is essential in order to obtain the best exposure in either suboccipital craniotomy or cervical laminectomy. We have sometimes found that sufficient flexion is not produced by the head rest, and traction by an assistant has been necessary. If a retractor is used it is usually applied in the region of the external occipital protuberance where only a scant purchase is possible, and if the retractor slips the tissues are likely to be stripped from the cranium or torn. Such traumatism where the corners of the incision come together is unfortunate, since it is the weakest part of the wound and, unless the tissues at this point are brought together accurately, leakage of cerebrospinal fluid may be favored. In order to obtain flexion and better exposure of the suboccipital region without additional traction,
Byron Stookey. A NEW HEAD REST FOR SUBOCCIPITAL CRANIOTOMY AND CERVICAL LAMINECTOMY. JAMA. 1922;79(10):823–824. doi:10.1001/jama.1922.26420100002014a