Making an Intraop Neuropathology preparation Starring Ed Plowey.

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Presentation transcript:

Making an Intraop Neuropathology preparation Starring Ed Plowey

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

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

Specimen arrival Labeling slides

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

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

Touch Prep Video uQ uQ

Pituitary adenoma TP Slide overview of Adenoma TP20X of adenoma Pituitary adenomas are diagnosed intra-operatively by Touch Prep ONLY

Preparing to do smear

Smearing: Specimen size

Smearing specimen size No Larger than tip of pencil 0.5mm 3

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

Smearing Video dhk dhk

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

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 (<0.5mm 3 ) IF specimen is biphasic – Make two slides or – Place small piece on opposite sides of slide

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

TEST

What is wrong with this smear?

Smear problems: Too much tissue Solution: Obviously use less

What is wrong with this prep?

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

What is wrong with this smear?

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

What is wrong with this TP?

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

What is wrong with this picture? No Gloves !