Monitoring

Gardner for tuberculum meningioma - SSEPs only, no EEG, no motors. 

Pre-op medications

• Mannitol 0.5 to 1.0 g/kg
• Dexamethasone 10 mg
• Keppra 1000 mg

Positioning

Supine, arm nearest the operator is tucked. Move patient so that their body is on the edge of the bed nearest the operator. 

Pinning

Head is pinned as it is for an EEA. Double pin on the left, single pin on the right. Lower double pin and the single pin go on the mastoid. The upper single pin goes straight up, towards the superior temporal line. 

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Arm is attached to the inside of the Mayfield. 

Tarsorrhaphy

Gardner: use 6-0 Prolene suture in a horizontal mattress. Suturing supplies are in a lumbar drain kit. First stitch goes on the upper eyelid, about 4 mm above the lid. Second stitch goes in the lower lid about 2 mm below the lid margin. Do not go on the tarsal plate or right above/below the lashes. 

Make sure you have the CV-11, not CV-1 needle.

The numbers describe the order of needle passes in the first image.

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Prep

Ophthalmic iodine for head. Chloraprep for fat graft site.

Draping

Three blue towels in a triangle around the eye. 

Four blue towels in a square for the fat graft site. 

Greenburg retractor

Always place the clamp on the Mayfield on the side opposite the pathology. 

Quiz questions​

• What are the bony connections of the clinoid? 
  • Roof of the optic canal
  • Lesser wing of the sphenoid
  • Optic strut
• What structure does the optic strut form when viewed from the inside of the sphenoid sinus? 
  • Lateral OCR
• What injury are patients prone to with the optic strut cut of the clinoidectomy? 
  • ​​​​​​​​​​​​​​Carotid injury