This chapter is obviously based on Chapter 4. Refining your technique to remove normal brain tissue is important, but not really the crucial point in brain tumor surgery. Hence, in this chapter you will be trained to remove tissue with a different consistency (we make it harder for you) with the option to get your first experience with fluorescence-guided surgery.1
Relevance for your daily practice
If you are starting to work on brain tumors, you will find this lesson very relevant, as it increases your dexterity in handling pathological tissue.
The objective of this chapter is to train your dexterity in removing pathological tissue.
In this chapter, we take your experience from Chapter 4 a little further. You will remove a brain tumor: actually it is not a brain tumor, but a lump of agar-agar. The crucial point is that in this scenario gentle suction and manipulation of the tissue will not be efficient. You will need to increase the force that you apply. On the other hand, rules from chapter 4 apply: you are very near to crucial, highly functional tissue.
You need set-up from Chapter 4 plus agar-agar, boiling water, a pink marker pen, and syringe with large bore needle (Fig. 5.1), as well as ultrasound (if available) and microscope with blue-light equipment.
As in Chapter 4, this exercise is not feasible in the OR.
For this chapter, you need to prepare the brains first. It will take less than 5 minutes, so you can do this before you start the exercise.
Preparation of the brain tumor: You can do this the day before, that is, at your home (see Video 7).