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Making an Intraop Neuropathology preparation

Learn the proper techniques for making an intraoperative neuropathology preparation, including specimen arrival, labeling slides, and smearing techniques. Watch the video tutorial for a step-by-step demonstration.

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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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