Microsurgical subpial resections for diffuse gliomas-old wine in a new bottle.

Abstract

Maximizing resection is an oft-sought-after albeit challenging goal in diffuse gliomas. Microsurgical technique remains the mainstay. By virtue of their pattern of growth and spread, gliomas respect anatomical boundaries like the pia. Using subpial dissection, en bloc resections provide the most optimal surgical technique. This paper revisits this technique and describes the rationale and basic principles integrating it in the modern multimodal glioma surgery workflow. Subpial resection is a very useful and "anatomical" technique for en bloc resection of diffuse gliomas which is easy to master and execute and optimizes the extent of resection and minimizes complications effectively.