The sub-pial resection technique for intrinsic tumor surgery

Area of Science:

• Neurosurgery
• Oncology

Background:

• The sub-pial resection technique, established in the early 1900s and refined by Penfield and Jasper, was primarily used for epileptic cortex removal.
• It has not been widely adopted for intrinsic tumor resection, where piecemeal aspiration is common, often leading to bleeding and obscured surgical planes.
• The authors advocate for the sub-pial technique's utility in supratentorial intrinsic tumor resections based on their experience.

Purpose of the Study:

• To describe the sub-pial resection technique for supratentorial intrinsic tumors.
• To present clinical decision-making guidelines for its application.
• To demonstrate surgical outcomes through representative cases.

Main Methods:

• Detailed description of the sub-pial resection technique.
• Inclusion of clinical decision-making guidelines.
• Presentation of illustrative cases to showcase application and results.

Main Results:

• The sub-pial technique preserves the pia, aiding in the protection and identification of normal anatomy (sulci, gyri, nerves, vasculature).
• Reduced bleeding enhances surgical safety and efficiency.
• En bloc resection is often achievable, facilitating accurate histopathology and research tissue acquisition.

Conclusions:

• The sub-pial technique is a viable strategy for resecting supratentorial intrinsic tumors.
• Applicable to temporal, frontal, occipital, and insular tumors.
• Effective in para-Sylvian or para-insular-sulcus locations.