How Dr. Mayfield Influenced Aneurysm Surgery
by John M. Tew, Jr., MD, and Mary Kemper, University of Cincinnati
Frank H. Mayfield, MD
Professor and Chairman
Department of Neurosurgery
University of Cincinnati College of Medicine and the Mayfield Neurological Institute Born June 23, 1908, Died January 2, 1991
AANS Member Between 1941 and 1991
A colleague of Dr. Mayfield described him as a creative thinker who "looked at things constructively, and when faced with a problem, changed it to an opportunity".' As we honor the contributions of Frank A. Mayfield, MD, to neurosurgery, we recognize the vision which enabled him to solve problems (e.g., massive hemorrhage, occlusion of the parent vessel) that patients had faced when undergoing operations for saccular aneurysms. The original aneurysm clips did not allow the surgeon to find a clip's optimal location and retain the closing force; once placed, it could not be removed and replaced. As a neurosur-geon and creative thinker, Dr. Mayfield collaborated with other physicians and scientists to develop an improved aneurysm clip, clip forceps, and headrest that forever changed aneurysm and brain surgeries.
More than 40 years ago, Frank A. Mayfield and medical artist George Kees, Jr., began working on the clip and forceps, later known as the "Mayfield clip." Dr. Mayfield had the idea to develop a small, cross-legged clip and an applicator with tweezers-like dexterity to permit for trial-and-error placement of the clip for the surgical treatment of aneurysms.2 Addition-ally, the metal clip would have to be malleable enough so that it could be twisted into shape and still retain its spring recoil.
The first Mayfield clips ranged in size from 6 to 15 mm and were made of 30 1 stainless steel. These clips tested in laboratory animals and later in patients to determine that there was no evidence of corrosion and minimal signs of foreign body reaction. Next, through additional studies, the clips were shown to remain in position against pulsatile forces of 400 mm of mercury. With these results, Dr. Mayfield and his colleagues were encouraged to use these clips during surgery in patients with saccular aneurysms.
Over the years, Dr. Mayfield worked diligently to improve the Mayfield clip and extend its applications. The clip under-went modifications after continued testing in the U.S., Great Britain, and Sweden by other noted neurosurgeons including James Poppen, James Gardner, Eben Alexander, Lawrence Pool, and Charles Drake. George Kees developed patents, and produced and marketed the Mayfield clips and appliers.
Modifications to the Mayfield clip followed. The Heifetz modification allowed the clip to be more firmly fixed in the applicator; the McFadden modification had a more rounded jaw and blunt tips made out of 301 stainless steel; Drs. Sundt and Nofzinger modified the clip making it useful for the treatment of patients with intracranial aneurysms; and Dr. Drake worked with Dr. Mayfield to develop a fenestrated clip through which the posterior cerebral artery could pass, thus facilitating occlusion of basilar terminus aneurysms. Dr. Tew recalls, "Dr. Mayfield received a call from Dr. Drake who was having difficulty operating on a basilar aneurysm. That night, Dr. Mayfield and Mr. Kees worked together in the laboratory, design-ing and making the modification, and shipped the clip to Dr. Drake. That clip would be called the Drake fenestrated clip."
Today's neurosurgeons and their patients continue to benefit from the innovative work of Dr. Mayfield. His commitment and compassion for humanity led to other far reaching improvements for patients with spinal disorders and neurological diseases, to a collaboration that led to the invention of the seat belt, and to the development of professional neurosurgical organizations. Once called the "conscience of neurosurgery" by Eben Alexander, Dr. Mayfield's legacy inspires us to tap on our own creativity for advancing the field of medicine.