Introduction– The accurate diagnosis of disease tissue is elementary to the precise diagnosis and proper management of central nervous system lesions. Although histopathology is gold standard, in neurosurgical practice intraoperative cytological diagnosis is now well established and emerge as a dependable standalone diagnostic tool. The rapidity at which sufficient preliminary information for optimal surgery is provided to neurosurgeons, help him take crucial decision regarding patients management. Overall soft nature of CNS lesions ,best suited for smear cytology, which in fact is the major restriction while performing intraoperative Frozen section consultation. So the present study was done to  assess the utility of squash cytology  in intraoperative diagnosis of CNS lesions.

Material and Methods–In this prospective  study 142 patients with clinical diagnosis of CNS lesions were studied. Patients clinical and radio  imaging findings were taken into account while evaluating squash smear preparation. Squash diagnosis was latter correlated with final histopathological diagnosis .

Results–Out of 142 cases, cytological diagnosis was offered in 136 cases. In  6 cases no opinion was possible on cytology.  Cyto–histological correlation was seen in 127 out of 136 cases, 9 cases remained discordant. Thus overall diagnostic accuracy of squash cytology in intraoperative diagnosis of CNS lesions in our study was 93.38%.

Conclusion– Intraoperative squash cytology is easy ,rapid, reliable and cost–effective technique for neurosurgical consultation with fairly high accuracy. Knowledge of clinicoradiological details  help to further improve  the diagnostic accuracy.