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 • http://www.youtube.com/watch?v=Koxv1L5gy uQ Pituitary adenoma TP Slide overview of Adenoma TP 20X 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 • 0.5mm3 Smearing • Slides can be held parallel or perpendicular (as shown here) Smearing Video • http://www.youtube.com/watch?v=7BFWS6Iz dhk Examples of good smears Useable area 2 parts of specimen on one slide Superb Smear 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 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 !