Craniotomy and skull base procedures require the head to remain completely immobile relative to the operating table throughout the procedure. Standard neurosurgical protocol designates the three-point skull clamp as the primary head immobilisation method for open craniotomies and select posterior cervical spine fusions. The mayfield skull clamp, recognised as the most widely used head immobilisation device in neurosurgical practice, achieves rigid fixation through calibrated pin torque applied within the sweatband zone, with 60 lbs of force applied as the standard for adult cranial procedures, consistent with established neurosurgical positioning protocol.