Karam Chand operation for Chiari 1 with Syringomyelia

Chiari 1 with Syringomyelia affects many people all over world. Disappointed with conventional surgery of adhesionolysis , tonsillar reduction, duraplasty early in my career, spanning from July 1983, I saw very unsatisfactory results and persistence of syrinx, author moved forward and started doing bony foramen magnum decompression and started putting syringosubarachnoid shunt at D1 level through a separate incision. D1 region because there is very prominent subarachnoid space here and you avoid working at sensitive cervicomedullary junction, so lower cranial nerves are not touched and no CSF leak occurs here. Dura is a pliable structure and pulsations expand it as in hydrocephalus. Moreover how can you achieve perfect arachnoid closure. The adhesions which one refer to are infact retiniculae. Dural band which many describe is like a dural ring elsewhere like intracranial carotid having around it. 71 surgeries have been done with my method with demonstrable Syringomyelia disappearance of signification reduction.