Frontal Glioma: Basic Dissection Principles
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Let's review the basic and fundamental principles for resection of high grade or low grade gliomas. This is the case of a 40-year old female who presented with a frontal low grade glioma, and subsequently underwent a right frontal craniotomy for resection of this mass. You can see the location of the masses, mainly interior frontal, involves the cortex and the white matter. And it's minimally or if anything not enhancing. You can see the choice of incision in this case, patient's head is placed in a neutral position. Relativity L-shaped incision is utilized, generous craniotomy is performed to expose the tumor and the surrounding normal brain. Neuronavigation is used. Pia surfaces are coagulated and cut. Larger parasagittal veins are protected. You can see the coagulation of the pia followed by sharp microsurgical techniques to disconnect the pia. And important maneuver that I would like to emphasize here is that I used the bipolar forceps, like scissors. While the forceps are on, I continuously open and closed the tips of the forceps and disconnect this colored or fibrous rubbery tumor from the surrounding relatively normal pre-tumoral areas. Suction is used to remove that part of the brain that has been coagulated or moisturized by repeated action of the bipolar forceps. Here, you can see that continuous opening and closing of the tips, and the use of the suction to assist in disconnecting the tumor mass. After the bulk of the tumor is removed, I perfectly inspect the resection cavity and assure that the rubbery discolored tumor, is adequately removed, and only the relatively glistening yellow white matter in the pre-tumoral area is left behind. Immaculate homeostasis is secured. Post-operative MRI, in this case, demonstrated reasonable removal of the tumor. Thank you.
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