3 - Intraoperative Consultation and Optimal Processing

In this chapter we discuss the various types of neurosurgical specimens that the pathologist might encounter when performing an intraoperative consultation. We also provide some tips on handling small specimens, which are frequently encountered in the world of neuropathology. The various techniques that can be utilized for cytologic preparations and their use as a complement to the frozen section are discussed here as well. Several artifacts may occur as a result of freezing brain tissue, and their occurrence in a frozen section can make interpretation of a specimen challenging; as such, being aware of these artifacts is critical. We have also discussed the controversial topic of intraoperative evaluation of margins in cases of diffuse gliomas; a topic that can generate substantial stress for an unprepared pathologist but a situation that can be handled effectively with a good understanding of the problem and open communication with the surgeon. Also, we provide some practical points regarding the handling of specimens in cases with suspected transmissible spongiform encephalopathies. Intraoperative consultation is an opportunity for the pathologist to provide information that can have significant impact on the outcome of a surgical procedure; although it can be challenging at times, it can also be a very rewarding experience.