CNS tumor
Intraoperative consultation / frozen sections

Author: Nat Pernick, M.D. (see Authors page)

Revised: 12 September 2017, last major update January 2006

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Frozen section neuropathology

Table of Contents
Definition / general
Cite this page: Pernick, N. Intraoperative consultation / frozen sections. website. Accessed June 20th, 2018.
Definition / general
  • Indications: (a) determine if lesional tissue is present, (b) determine if adequate sampling, (c) provide preliminary information to assist neurosurgeon (see below) and (d) perform special techniques (culture, B5 for lymphoma, touch preparations)
  • Need not give definitive diagnosis
  • Should not grade astrocytic glial neoplasm unless is clearly a glioblastoma (since tumors often have variable grades)
  • For some tumors, attempts at total resection are made (meningioma, schwannoma, solitary metastases, cysts, ependymoma, hemangioblastoma, cerebellar pilocytic astrocytoma, craniopharyngioma) so intraoperative consultation may be helpful
  • Recommended to assess undefined lesions by both frozen section and cytologic preparation
  • Cytologic preparation: adds fine nuclear detail, reveals glial type processes or epithelioid features of carcinomas; shows discohesiveness associated with pituitary adenoma, oligodendroglioma, medulloblastoma or lymphoma; may be more accurate than frozen section (Stereotact Funct Neurosurg 1995;65:187)
  • Recommended to obtain touch preparations (touch glass slide to wet tissue, fix before it dries, then stain)
  • Artifacts: long empty cavities in parenchyma (due to cryostat) vs. microcysts which contain cells and eosinophilic proteinaceous material)
  • References: Arch Pathol Lab Med 2005;129:1635, Arch Pathol Lab Med 1997;121:481, Mod Pathol 1988;1:378, J Neurol Neurosurg Psychiatry 1988;51:332, Arch Pathol Lab Med 2005;129:1653