MATERIAL and METHODS: Twenty-nine patients with posterior fossa pathology or cervical pathology were included in this study. All patients were operated in the Concorde position. The three-pin holder was placed with an obtuse angle while the patient was in the supine position as shown in figure 1a. The angle between the handle of the three-pin holder and the floor was measured in the supine and prone positions as shown in Figure 1A,B.

RESULTS: The average angle between the floor and the handle of the three-pin holder in the supine position and the Concorde position was 135 degrees (SD ± 5.45) and 95 degrees (SD ± 3.26) respectively (Figure 4) All the patient's body including the shoulders was within the borders of the operation table.

CONCLUSION: The placement of three-pin holders with an obtuse angle in the supine position provides three advantages: easier manipulation during neck flexion especially for cervical vertebral pathology, much less body weight loading on the three-pin holders during surgery, and less flexion of the neck to expose pathology located in the cervical or posterior fossa region. Keywords : Concorde position, Obtuse angle, Posterior cervical, Posterior fossa, Threepin holder