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Introduction:Anterior cranial fossa (ACF) defects still remains a reconstructive challenge to neurosurgeons due to the difficult location, inaccessibility, and unfavorable vascular anatomy. Usual reconstructive methods reported complications such as recurrent cerebrospinal fluid leak due to bone resorption and tissue breakdown. This is mainly due to the avascularity of the bone graft and inability to provide bony structural support for the skull base. An ideal reconstructive modality should provide a rigid bony support to prevent brain herniation as well as ensure a water tight barrier between sinonasal tract and intracranial compartment.Methodology:Hence, we thought of a novel technique of taking the outer table of the primary craniotomy flap with its intact myofascial pedicle and moulded it with multiple osteotomies (moulded osteomyofascial pedicled split (MOPS) craniotomy flap) to fit into uneven ACF defects. Advantages of our flap include (1) It is a pedicled vascularized bone flap. (2) It is taken from primary craniotomy flap; hence, no separate craniotomy is required. (3) The inner table is intact and leaves no secondary calvarial bone defect on the donor site. (4) Osteoplastic flap is moulded to fit into the defect, thus providing good contour.Results:MOPS flap was used in five patients with ACF defects due to varied etiologies such as encephalocele defect, frontal mucocele, skull base meningioma, and complex naso ethmoid fracture. Age of the patients included in the study varied from 21 to 60 years. Male:female ratio was 4:1. ACF defects were reconstructed using MOPS flap in all cases. There were no postoperative complications and 1-month postoperative computerized tomography scan showed no evidence of bone resorption with acceptable cosmesis.Conclusion:MOPS craniotomy flap provides a novel, easily mastered, and cost-effective technique with minimal complication in reconstruction of complex ACF defects with acceptable esthetic and functional outcome.

Surgical training is different from medical training where resident learns from doing surgeries and observing surgical skills from the senior faculty in addition to reading books. There is insufficient literature regarding the lacunae in current surgical training in our medical colleges. Aim of the survey is to identify the determinants of academic satisfaction of neurosurgery residents undergoing the present surgical training program in kerala.This survey determines the factors affecting academic satisfaction from a student perspective which will definitely be an eye opener regarding the benefits as well as drawbacks of the present curriculum in Kerala. MATERIALS AND METHODS A descriptive cross sectional survey of neurosurgery residents was done using a prevalidated questionnaire and send by email . It covered demographics ,the overall satisfaction and variables related to aspects of residency training like 1)surgery related 2)clinical care related 3) education related variables which are collected on a 5 point leikert score scale and scored. Responses obtained were enterd in SPSS data sheet and analysed . RESULTS The response rate was 60% .The average age of surgery residents in our survey was 30.4±2.59 years,majority being males (83%).Majority(41.7%) of residents who participated and responded to the survey were satisfied with the current surgical training. The residents were more satisfied if 1)faculty allowed residents to perform the important steps in the operations but without being overly supervised (p=0.049) 2)if they scrubbed more than 25 cases last month(p=.011); and 3) if they involve with the faculty in management decisions.(p=.032). CONCLUSION: The survey highlighted that faculty should support and give residents freedom to share a keyrole in patient management decisions .Improving resident satisfaction may help encourage more medical students to enter neurosurgical profession.Present survey will definetly guide curriculum management committees in health universities

Background: The pressure of the chronic SDH (subdural haemotoma), the age of the patient, preoperative GCS score and midline shift were considered prognostic dependent factors. The study aimed at the significance of the pressure of chronic SDH in the outcome of patients.Methods: A correlation between subdural hematoma pressure and preoperative and postoperative clinical variables such as hematoma volume, midline shift, age, GCS score and postoperative modified ranking scale score as well as complications were assessed and analyzed.Results: According to the pressure of chronic SDH, 56 patients were grouped into 4 groups. In the pressure group <15 cm/h20 group the mean age was 85 and postoperative ranking score was 3 and the recurrence was 21 % while in high pressure group (>25 cm/h20) the mortality was 14% and no recurrence.Conclusions: The pressure of the chronic SDH has significant prognostic value in chronic SDH surgeries.

Background: Meningiomas are one of the most common primary intracranial tumours. The incidence, varieties of tumour, site, imaging findings, resectability, outcome and prognosis vary from tumour to tumour. The understanding of these characteristics is essential in the management of meningiomas.Methods: An observational study was carried out among 50 patients with imaging proven meningioma and involved recording of age, gender, clinical history, physical examination, imaging findings, intraoperative characteristics, anatomical and pathological diagnosis. The parameters evaluated in the study were gender distribution, age distribution, presenting symptoms, neurological deficits, mri findings, volume of tumour, intraoperative findings, grade of excision, anatomical, pathological diagnosis and recurrence rates.Results: The male to female ratio was 1:2.57, with 50-70 years being the most affected population. The common symptomatology was that of features of raised ICP with motor deficit as the common neurological abnormality. Simpson grade 2 was the common clearance obtained. 3 common sites were parasagittal, sphenoid wing and convexity. Commonest histological type was transitional. Recurrence rate was 6%. This study also pointed out general imaging and intraoperative characteristics of Grade 3 tumours as T2 hyperintensity, heterogeneous, with significant perilesional oedema and intensely contrast enhancing, high vascularity, friable, suckable and ill-defined margins.Conclusions: The study enables us to understand the general trend of presentation, imaging and surgical properties of Meningiomas and to compare with international standards. It also helps us to finger out the possible high-grade lesions even before the pathological diagnosis is obtained.