title: Brain Tumor Interface Dissection Technique with Surgical Blade from Laboratory to Neurosurgical Operating Room.
abstract: BACKGROUND
  Ideal tumor resection requires brain/spinal cord tumor interface separation in perfect and precise surgical planes within a few micrometers for radical tumor resection and maximum normal tissue preservation. Despite the availability of several dissection techniques, the search for additional alternatives and an ideal technique continues. We evaluated the feasibility and advantages of dissection using a No. 15-blade scalpel in special brain tumor surgery situations. We developed a leaf model wherein its outer layer is progressively dissected from its inner skeleton using a scalpel. An additional model used was a tomato wherein its skin was peeled off its pulp using the same technique.
  
  
  OBJECTIVE
  We developed an inexpensive leaf model. A scalpel knife was used in a microneurosurgical setting, and the leaf's outer layer is peeled off. The technique is then used in an operating room setup where surgery on extra-axial tumors like meningiomas and intra-axial brain and spinal cord tumors is done.
  
  
  METHODS
  A No. 15 scalpel was used for dissection between the layers of the Peltophorum pterocarpum leaf model. This dissection method was compared with other neurosurgical dissecting tools.
  
  
  RESULTS
  We dissected 120-μm thick leaves into 2 layers with removal of an 18- to 55-μm thick layer. Leaving behind a transparent layer was possible using a No. 15 blade scalpel. Similarly, it was possible to preserve a 35- to 40-μm thick arachnoid layer that separated a meningioma from the underlying brain parenchyma.
  
  
  CONCLUSIONS
  A scalpel with a sharp edge could be used to perform precise and fine dissection. The scalpel deserves to occupy a place of pride as a dissecting tool in neurosurgery.
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Mumbai, India. Electronic address: rskrrai@gmail.com.
authors.forename: Survendra Kumar R
authors.initials: SKR
authors.lastname: Rai
authors.affiliation: Division of Neurosurgery, Department of Neurology and Psychiatry, University of Rome "Sapienza", Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mancarella
authors.affiliation: Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Mumbai, India.
authors.forename: Atul H
authors.initials: AH
authors.lastname: Goel
mesh_terms: D040761:Biomimetic Materials; D001932:Brain Neoplasms / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D006801:Humans; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D018515:Plant Leaves; D013125:Spinal Neoplasms / Q000601:surgery*
keywords: Brain tumors; Meningioma; Microdissection technique; Microsurgery