https://www.selleckchem.com/MEK.html The best surgical treatment for adult Chiari malformation type 1 remains widely debated. This study aimed to assess the efficacy of posterior fossa decompression and duraplasty with arachnoid preservation compared with arachnoid dissection for the treatment of adult Chiari malformation type1. Two reviewers (M.O.-G. and M.A.) performed a PubMed, MEDLINE, and Embase literature search using the following terms ("Chiari" OR "Chiari 1") AND ("duraplasty" OR "arachnoid preservation" OR "arachnoid spar∗" OR "posterior fossa surgery" OR "posterior fossa decompression" OR "foramen magnum decompression"). Studies assessing the efficacy of posterior fossa decompression with duraplasty for the treatment of patients aged >18 years with Chiari malformation type 1 were included. Case reports with <10 patients, editorials, and non-English studies were excluded. Of 195 studies identified, 24 were included for meta-analysis. In the 1006 participants, there was no difference in postoperative clinical or radiologic malformation type 1 and reduces the risk of complications, particularly cerebrospinal fluid-related complications and the rate of reoperation. The Mayfield skull clamp is the most commonly used 3-pin head immobilization device. It is routinely used in cranial neurosurgical procedures and selected cervical procedures. Despite its role in some serious complications, guidelines and nuances on the correct application of the Mayfield clamp are lacking. The goal of this article was to present an overview of the complications associated with the Mayfield skull clamp. We also present a conceptual framework of the correct use-in our opinion-of the Mayfield clamp in several standard approaches to avoid the most common complications. PubMed was searched for original articles published between 1980 and 2020 with the search terms "Mayfield skull clamp" and "Mayfield head clamp." Eligibility criteria were availability of English abstract and complicati