Microsurgical subpial resections for diffuse gliomas—old wine in a new bottle

• Published in: Acta neurochirurgica Vol. 162; no. 12; pp. 3031 - 3035
• Main Authors: Mishra, Ajit, Shetty, Prakash, Singh, Vikas, Moiyadi, Aliasgar
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.12.2020; Springer Nature B.V
• Subjects: Brain Neoplasms - surgery; Glioma; Glioma - surgery; How I Do it - Tumor - Glioma; Humans; Interventional Radiology; Medicine; Medicine & Public Health; Microsurgery - methods; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - methods; Surgery; Surgical Orthopedics; Tumor – Glioma; Workflow; Fluorescence; En bloc resection; Glioma; Subpial resection; Ultrasound
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-020-04524-1

Background Maximizing resection is an oft-sought-after albeit challenging goal in diffuse gliomas. Microsurgical technique remains the mainstay. Method By virtue of their pattern of growth and spread, gliomas respect anatomical boundaries like the pia. Using subpial dissection, en bloc resections provide the most optimal surgical technique. This paper revisits this technique and describes the rationale and basic principles integrating it in the modern multimodal glioma surgery workflow. Conclusion Subpial resection is a very useful and “anatomical” technique for en bloc resection of diffuse gliomas which is easy to master and execute and optimizes the extent of resection and minimizes complications effectively.