Intraoperative consultation is a routinely practiced technique whereby fresh tissue samples are rapidly processed and examined by a pathologist in order to provide crucial diagnostic information to the operating surgeon that will affect the subsequent course of the operation. Neurosurgical cases quite frequently require intraoperative consultation. Although many larger institutions have neuropathologists who routinely handle CNS samples, elsewhere this duty falls to the general surgical pathologist. The relatively small volume contributes to a lack of experience in this highly specialized field, resulting in a high intraoperative consultation error rate.

This course, designed for both practicing community general surgical pathologists and pathology trainees, will use a combined didactic and case-based approach to highlight a practical approach to handling neurosurgical intraoperative consultations. The specific topics that will be covered include: 1) Be Prepared! "Must Know" Pre-intraoperative Consultation Information, 2) Neuroimaging 101: Practical Neuroradiology for the General Surgical Pathologist, 3) Preparing High Quality Cytologic and Frozen Section Slides, 4) Dealing with the Neurosurgeon: What Does the Surgeon Need to Know to Complete the Operation? Each section of the course will include 2-6 case presentations to illustrate the principles presented.

Virtual slides with corresponding case histories and radiographic images will be posted on the USCAP website for review by pre-registrants prior to the course. Provided at the course will be a comprehensive syllabus featuring helpful tips for specimen processing and workup, as well as differential diagnoses of various neuroimaging, cytologic, and histologic findings. All course registrants will also receive web access to the course PowerPoint presentations as well as the text portion of the syllabus.

Upon completion of this educational activity, participants should be able to: 1) Evaluate critical clinical information (patient age, anatomic location of the lesion, basic Magnetic Resonance Imaging results) for consistency with the histopathologic diagnosis; 2) Implement effective specimen handling strategies in their daily practice to minimize intraoperative consultation misdiagnosis; 3) Choose the appropriate cytologic preparation (imprint, smear, scrape, or drag) for a given brain biopsy tissue sample that will yield optimal diagnostic information that is complementary to the architectural information provided by the frozen tissue section; and 4) Identify and take effective action when encountering the most common problematic issues that arise during intraoperative consultation for neurosurgical specimens