Surgical Neuropathology
 Active neurosurgery, neurology and ophthalmology services provide a diverse array of CNS/ PNS tumors, neuromuscular tissue, ocular specimens, pituitary tumors and brain biopsies, in addition to consultation material. Under faculty supervision, the neuropathology trainee directly participates in evaluating the specimens for intra-operative diagnoses. Key elements of neurosurgical pathology training are: 1) learning to properly sample the fresh surgical specimens for intraoperative evaluation, 2) performing both tissue-smear and frozen section preparations, as deemed suitable by the nature of the case, 3) providing diagnostic interpretation of tissue-smear and frozen section preparations and discussing the differential diagnoses with the neurosurgeons, 4) selecting the appropriate special histochemical, immunohistochemical, ultrastructural, and molecular analytical procedures to perform on the processed tissue and 4) making the final histopathologic diagnosis, based on routine, histochemical special stains, immunohistochemistry, in situ hybridization and ultrastructural features. Recognizing that stereotactic and limited biopsies will be more routinely used in the future for neurosurgical diagnosis, this program intensely emphasizes the cytologic brain smear technique for intraoperative diagnostic consultation. The expertise acquired by the trainees in this technique provides an important dimension to the skills necessary for surgical neuropathology. This is combined with the regular use of immunohistochemistry and special histochemical stains for providing optimal correlation of the permanent tissue section data to the cytologic smear findings. For muscle specimens, evaluation also includes the interpretation of muscle enzyme histochemistry and ultrastructural analysis. For the formulation of the final neuropathologic diagnosis, an emphasis is placed on the integration of clinical history, serum and CSF laboratory data, and neuro-imaging features.
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