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Making an Intraop Neuropathology preparation

This guide details the intraoperative neuropathology preparation process as demonstrated by Ed Plowey. Key steps include the gentle teasing of specimens onto a saline-moistened Telfa pad, precise labeling of slides, and immediate fixation techniques essential for accurate diagnosis. Specific instructions for touch prep techniques, specimen size guidelines, and solutions for common preparation issues are provided. The guide emphasizes timely fixation to ensure specimen viability for frozen section analysis, integrating video resources for visual learners.

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Making an Intraop Neuropathology preparation

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  1. Making an Intraop Neuropathology preparation Starring Ed Plowey

  2. Surgeon obtains specimen • Tissue within needle is gently teased onto saline MOISTENED (not soaked) Telfa

  3. Set up • Instruments: Clean surface, Scalpel, Fine forceps, labeled slides, OPEN Fixative jar

  4. Specimen arrival • Labeling slides

  5. Touch Prep • Either: • Turn slide frosted side down and touch to entire specimen Or if specimen firm (e.g. meningioma) • Pick up with forceps and dab twice to slide • DO NOT SLIDE OR SWIRL • FIX IMMEDIATELY • i.e. ASAP • i.e. in less than 1 second

  6. Touch Prep Turn slide frosted side down and touch entire specimen • FIX IMMEDIATELY i.e. ASAP i.e. < 1 second

  7. Touch Prep Video • http://www.youtube.com/watch?v=Koxv1L5gyuQ

  8. Pituitary adenoma TP Slide overview of Adenoma TP 20X of adenoma Pituitary adenomas are diagnosed intra-operatively by Touch Prep ONLY

  9. Preparing to do smear

  10. Smearing: Specimen size

  11. Smearing specimen size • No Larger than tip of pencil • 0.5mm3

  12. Smearing • Slides can be held parallel or perpendicular (as shown here)

  13. Smearing Video • http://www.youtube.com/watch?v=7BFWS6Izdhk

  14. Examples of good smears Useable area 2 parts of specimen on one slide Superb Smear

  15. Summary: Set up: Key features • Slides labeled • Specimen on moist Telfa pad • Not Dry: Not immersed in saline • IF specimen uniform • Cut off piece up to (but not exceeding) size of tip of pencil (<0.5mm3) • IF specimen is biphasic • Make two slides or • Place small piece on opposite sides of slide

  16. Common problems / solutions • Too much tissue on slide • Use less • Air drying • Be sure fixative jar (95% ethanol) is open and adjacent to prep site • Drop slide into jar for fastest fixation • No tissue touches off or smears • Move on to frozen section

  17. TEST

  18. What is wrong with this smear?

  19. Smear problems: Too much tissue • Solution: Obviously use less

  20. What is wrong with this prep?

  21. TP/Smear Problems: Air dried • Solution: Have fixative jar open and closer before starting prep

  22. What is wrong with this smear?

  23. Not enough material all at bottom of slide • Solution: Start by placing specimen ½” from frosted end of slide

  24. What is wrong with this TP?

  25. Specimen not touching off • Try smear and if that doesn’t work go to frozen

  26. What is wrong with this picture? No Gloves !

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