• Put the bottom pins down so the head sits there (usually start with 45mm is a good bet)

• Align center of nose to center of smiley face
• To re-position, lift head off bottom pins then translate in space, do not try to turn the face on pins, it will go right back 
• The back pins should be about level of mid ear so as not to get too low above transverse sinus 

Connect to ROSA 

• Raise OR table to level of ROSA 
• Drive ROSA in 
• Use ROSA connectors to fix the head 
• Now remove one of four posts 
• Make sure you pad the patient if their neck is is large from the back and pressing on the frame bars 

Draping

• No towels 
• Drape ROSA arm with plastic cover 
• 2x open drapes, one going to ROSA one going onto patient, then a flat blue drape stapled  

Drilling

• Drill through skin
• adjust drill to ~1cm for bone 
• once through bone, puncture dura with dural puncture after measuring additional ~1cm 
• Implant drill bit 
• insert all leads at the end 

Connecting

• Put 3 grounding wires in sagittal midline plane from forehead to back of head 
• Connect all leads 

Headwrap 

- retention loop for all leads, nylon stitch x 3 

- Baci then 4x4 over the leads  

- Curlex x 2 starting from chin/neck and going up, then go down from forehead to neck 

- stockinette over curlex

- Tape 

- Suture curlext to stockinette

- Tape the specimen bag to patients forehead 

Orders

- post-op CTH IGS 

- HOB > 30 

- Ancef x 24 days 

Figure 1: Sea