September 09, 2014
Let's go ahead and review the basic principles for resection of GBMs and the superficial ones. This is a 56 year old male who presented with episodic confusion, underwent imaging, which revealed a classic GBM, a ring enhancing lesion in the right posterior temporal area. He underwent a standard craniotomy over the lesion. You can see the dura was open in a cruciate fashion. Small corticotomy was created just over the apex of the tumor where the mass reached the brain surface. After the corticotomy was completed, you can see the margin of the tumor was better defined. Some of the tumor was removed using pituitary rongeurs for purpose of frozen section. I used the bipolar forceps at a higher intensity level and emulsify the tumor to be able to use the suction device to evacuate the tumor. The tumor has a different response to the bipolar forceps than the normal brain, and this difference in response guides me in gross total removal of the mass. Fluorescein fluorescence can also be quite effective in removal of the tumor. Here you can see the underlying space beyond the areas of the resection cavity are also inspected to assure complete removal of the tumor. You can see the glistening white surface of the white matter. The peritumoral area that is not affected by tumor. I often used thrombin solution to irrigate the resection cavity to achieve better hemostasis. When the brain is inflamed and additional bipolar coagulation can actually lead to more bleeding. And here's the postoperative MRI, which revealed there is resection of the mass without any complicating features. Thank you.
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