Neuropathology Intraoperative Consultation

The goals of surgical neuropathology intra-operative consultation, (IOC), are to confirm sampling of diagnostic specimens and to guide surgical approaches. Understanding the clinical and imaging findings, and clear communication with the neurosurgeons, are critical for IOC to be informative. While neuropathologists typically lead this process at large academic institutions, other institutions may rely on surgical pathologists to provide neuropathology IOC. Thus, a stepwise approach for the evaluation of neuropathology specimens can be valuable. This review provides a diagnostic algorithm for neuropathology IOC and illustrates its utilization through nine example clinical vignettes. Pre-operative clinical and imaging findings, differential diagnosis, and critical diagnostic pitfalls are discussed. We discuss key findings that should be conveyed to the neurosurgery team at the time of IOC for optimal specimen handling and surgical guidance, to ensure adequate tissue sampling for subsequent pathologic and ancillary studies.