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Approach to the Intraoperative Consultation for Neurosurgical Specimens

Somerset, Hilary Lynch MD*; Kleinschmidt-DeMasters, Bette Kay MD

doi: 10.1097/PAP.0b013e3182169934
Review Articles

Intraoperative consultation remains an invaluable tool in the initial evaluation of surgically excised specimens. Good communication is required between the pathologist and surgeon to obtain the best care for their mutual patient. Intraoperative consultation (frozen section, FS) provides a preliminary diagnosis for the surgeon and aids in guiding his/her subsequent surgical approach. For the pathologist, it serves to assess tissue adequacy in the context of the clinical and imaging features of the patient. FS can guarantee that the surgeon is in the desired anatomic location, but most often serves to ensure that adequate amounts of abnormal, and likely diagnostic, tissue will be available to the pathologist to render a final diagnosis on permanent sections. The preliminary evaluation of tissue at the time of intraoperative FS also guides the pathologist in the ordering of ancillary studies, some of which need to be performed on fresh or frozen tissues and must be sent at the time of the intraoperative consultation. This brief review will specifically focus on the role of the pathologist who is called to perform a FS for a neurosurgical specimen. We will discuss (1) the goals of the neurosurgeon for the intraoperative consultation, (2) how to achieve optimal communication between neurosurgeon and pathologist at the time of the FS, (3) what constitutes reasonable and unreasonable expectations by the neurosurgeon for the FS, (4) choices of techniques that can be used by the pathologist, (5) what tissue should be triaged, and (6) common discrepancies between FS and permanent section diagnoses in central nervous system disorders. The published literature on FS and permanent section discrepancies will be briefly reviewed so that pathologists will understand that some difficulties are inherent in neurosurgical specimens and are not specific to their practice, or to a given pathologist. Hopefully, this knowledge will enhance pathologists' confidence as they negotiate how best to handle this time-sensitive, and sometimes angst-producing, task.

Departments of *Pathology

Pathology, Neurology and Neurosurgery, Anschutz Medical Campus, University of Colorado at Denver, CO

The authors have no funding or conflicts of interest to disclose.

Reprints: Bette Kay Kleinschmidt-DeMasters, MD, Department of Pathology, MS F768, 12605 E, 16th Avenue, Room 3026, Aurora, CO 80045 (e-mail: All figures can be viewed online in color at

© 2011 Lippincott Williams & Wilkins, Inc.