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Chiari 1 malformation has crowding at craniovertebral junction (CVJ), treated by Foramen magnum decompression (FMD) but is associated with high failure rates, which is explained by recently introduced concept of central instability. So, we propose a new concept of relieving this crowding without affecting stability.To derive a threshold for coring out of internal surface of C1 posterior arch instead of complete laminectomy accompanying FMD.We prospectively included nine patients with a mean age of 25.33 ± 7.97 years, diagnosed with ACM-1 without AAD, who were operated with FMD and lax duraplasty and C1 laminectomy. The preoperative dural diameter and area covered under the dura at the level of C1 were measured and compared with the postoperative state. Results were analyzed to derive a cut-off threshold which could be drilled from the inner aspect of C1 arch.The postoperative AP diameter of the dura increased statistically significantly from pre-op; however, the AP extension was less than the preoperative diameter with posterior arch included. Likewise, the area spanned by the dura increased statistically significantly from pre-op but was less than the cumulative area of dura with C1 arch included in pre-op. Analyzing all, a mean cut-off of 50.58% was achieved.The authors suggest FMD with partial coring (~50%) of the inner part of arch of C1, instead of full-thickness laminectomy with a wider length of coring as the target, and this will serve the purpose intended, without increasing mobility.

INTRODUCTION Referring to a rare post-operative complication associated with craniopharyngioma surgery, Vasospasm. A number of possible causative factors have been postulated, like tumour encasing vessel, handling of vessels during surgery, but none have been able to explain delayed complication. Thus, we have evaluated series of patients operated in a single centre, to look for the possible aetiology METHODS Patient’s data have been collected retrospectively in the past 4 year, from a single centre, and cases that developed post-operative neurological deficit/vasospasm, proven clinically and/or radiology were included. Of 116 patients operated 6 were found to have clinical deterioration, and were confirmed using transcranial Doppler and/or radiologically demonstrable vasospasm. Each case was analysed retrospectively, and relevant variables were studied. RESULTS Patients developed neurological deficit/vasospasm ranging from Post-operative day 2 to second week after surgery. 1 expired, 2 improved over time, and 3 had persisting deficits. On evaluation, fluid balance showed changes, with serum Sodium levels. However, change of status from high volume status to low volume status was seen in almost all. CONCLUSIONS Development of post-operative neurological deficit/vasospasm is usually a cumulative result of some intraoperative insult like vessel handling, which could be a predisposing factor, and various post-operative factors like change In volume status, serum electrolytes levels, hormone status levels. Most important of all is to have an early and low threshold level to diagnose it, as early detection and action may a significant and possibly preventable morbidity or mortality

The present study is to assess the ability of topical mitomycin-c to prevent the recurrence of surgically excised keloid / hypertrophic scar. The study was a prospective randomized controlled trail on 24 patients. The study was conducted on two groups of patients i.e. study (case) in which mitomycin-c applied topically on resected bed (0.5 mg/ml for at least 5 minute) & Control in which mitomycin-c not applied /or intralesional steroid is used. The cases are followed up pre operatively as well as 1 and 6 month post operatively. We found that no significant beneficial effect have been observed if mitomycin c (case) is used topically on resected bed after surgical excision of