Frozen section can 'sharpen' or 'sand off' the surgeon's knife: Two case Illustrations with skull base meningioma mimics.

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Frozen section can 'sharpen' or 'sand off' the surgeon's knife: Two case Illustrations with skull base meningioma mimics.

World Neurosurg. 2017 Aug 22;:

Authors: Karthigeyan M, Salunke P, Gupta K, Singh A, Rajasekhar R

Abstract
OBJECTIVE / BACKGROUND: Lesions at skull base merit careful evaluation of imaging and meticulous preoperative planning. Their needless radical resection could add to surgical morbidity. Occasionally, dura-based inflammatory/ infectious lesions at this site radiologically mimic meningiomas, which are the commonly encountered entity at this site. Not all require excision; rather it could be harmful in few.
CASE REPORT: We describe two patients with skull base lesions that apparently resembled a meningioma on imaging, while the frozen section in both cases was contrary to the pre-operative diagnosis with inflammatory lesion in the first and invasive aspergillosis in the second case. Formalin-fixed paraffin embedded sections confirmed the frozen section diagnosis. Safe resection was performed in the former while surgery was abandoned and the patient started on antifungal therapy in the latter. Both had good outcome.
CONCLUSION: The present report thus underscores the usefulness of intraoperative frozen section to decide on further course of treatment when faced with such unexpected situations. Frozen sections/ crush smears hold a great potential to avoid unwarranted surgical morbidity, particularly for skull base lesions.

PMID: 28842226 [PubMed - as supplied by publisher]

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