Show pageBacklinksCite current pageExport to PDFBack to top This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong. ====== Subpial Dissection ====== ===== 🔍 Definition ===== **Subpial dissection** is a [[microsurgical technique]] in which the surgeon operates beneath the pia mater, maintaining it as a protective membrane between the surgical field and the underlying brain cortex. This approach allows lesion removal or exposure of deep structures while minimizing cortical injury and preserving vascular integrity. ===== ⚙️ Surgical Technique ===== * Identify the **pial surface** under high magnification. * Incise the **pia mater sharply** using a microknife or fine bipolar forceps. * Continue dissection **beneath the pia**, using gentle suction and blunt dissection tools. * The pia is kept **intact over the brain parenchyma**, and the dissection proceeds **between the pia and the lesion or arachnoid**. * Achieve meticulous **hemostasis** using bipolar coagulation at the pial edge, avoiding direct cortical coagulation. ===== 🧠Indications and Applications ===== * **Tumor surgery**: low-grade gliomas, meningiomas invading the cortex * **Vascular lesions**: AVMs, cortical aneurysms * **Access to deep structures**: * Transsylvian approach * Transcortical approach * Transplanum–transpolfar approaches (endonasal) * **Epilepsy surgery**: selective amygdalohippocampectomy, disconnections ===== 🛡️ Advantages ===== * Preserves **cortical and vascular integrity** * Reduces risk of **neurological deficits** * Minimizes **postoperative seizures** * Allows **safe retraction and exposure** of eloquent areas ===== ⚠️ Risks and Considerations ===== * Risk of damaging **subpial vessels** (possible infarcts) * Infiltrative or inflammatory lesions may **obscure the subpial plane** * Requires **microsurgical precision** and excellent visualization ===== 🧠Key Anatomical Notes ===== * The **pia mater** contains pial vessels and marks the outermost layer of the cortex. * Subpial dissection preserves **arachnoid and vascular layers** while accessing lesions directly beneath the cortical surface. ===== 📚 References ===== * Yasargil MG. ''Microneurosurgery''. Volumes I–IV. Thieme. * Berger MS, Hadjipanayis CG. Surgical techniques for infiltrating gliomas. ''Surg Neurol''. 2007. * Spetzler RF, et al. Use of subpial planes in eloquent cortex surgery. ''Neurosurgery''. 1992. subpial_dissection.txt Last modified: 2025/07/11 09:39by administrador