subpial_dissection

Subpial Dissection

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.

  • 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.
  • 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
  • Preserves cortical and vascular integrity
  • Reduces risk of neurological deficits
  • Minimizes postoperative seizures
  • Allows safe retraction and exposure of eloquent areas
  • Risk of damaging subpial vessels (possible infarcts)
  • Infiltrative or inflammatory lesions may obscure the subpial plane
  • Requires microsurgical precision and excellent visualization
  • 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.
  • 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 09:39
  • by administrador