gms | German Medical Science

Introduction: A recent web search revealed 161 neurosurgical and only 40 neuropathological facilities in Germany; i.e. about 64% of neurosurgical facilities have limited or no access to neuropathological expertise.

Objectives: Delineate problems that arise if neurosurgeons operating on mass lesions are not guided by on-site neuropathologists.

Method: Review of different perspectives and models with different quality and quantity of neuropathological service for neurosurgeons.

Results:

Shipping problems. The greater the distance between the neuropathologist and the probe, the worse gets three problems.

1.

Probes will get lost and a diagnosis made impossible. To prevent this, a backup or an additional biopsy will be needed.

2.

Probes will be spoiled. Many probes are very small and dry out or decay fast. Thus, the quality of the diagnosis is in danger because especially immunohistochemistry or molecular methods might not work anymore.

3.

The diagnostic process is delayed.

Extent of surgery. One ultimate goal of neurosurgery is to minimize trauma to intact brain structures. This includes not only eloquent brain areas as there is of course no brain tissue that is not needed. We eventually just don’t know it’s exact function.

A good clinical neuropathologist will guide the neurosurgeon during surgery and save brain tissue by immediately determining the representativity and working diagnosis of the probe. By on-site self-made cytological imprints and smears specimens can be even further reduced in size. Without a qualified intraoperative neuropathological diagnosis three problems arise.

1.

Neurosurgeons tend to take out bigger (too large) specimens to increase the chance of representative probes.

2.

In case of non-representative specimens eventually the biopsy has to be repeated.

3.

Resections of lesions where a biopsy would be preferably, e.g. lymphoma, abscess or radiation necrosis.

Conclusion: It is not reasonable for our patients to withhold them an experienced neuropathologist on-site during neurosurgery of mass lesions. The neuropathologist on-site prevents losing or spoiling specimens. He optimizes expenditure of time and quality of diagnosis. He spares brain tissue and prevents unnecessary second surgeries or over-treatment.