Operative Planning

• Review imaging (magnetic resonance imaging ± contrast with magnetic resonance venogram to evaluate draining vein pattern and sinus patency; computed tomography to evaluate bone changes, calcium)
  
• Angiography may be useful for large tumors for consideration of preoperative embolization and evaluation of venous drainage and sinus involvement
  
• Intraoperative frameless stereotaxy as necessary
  
• Preoperative steroids for significant edema
  
• In patients with symptomatic mass effect, preoperative embolizing can precipitate worsening of clinical condition; embolization timing must be coordinated with surgery soon thereafter

Equipment

• Craniotomy tray
  
• High-speed drill
  
• Frameless stereo axy
  
• Mayfield head holder
  
• Yasargil bar and Greenberg retractor

Operating Room Set-up

• Headlight
  
• Loupes
  
• Bipolar cautery and Bovie cautery
  
• Microscope (prepare if necessary)
  
• Ultrasonic aspirator for large, soft tumor

Anesthetic Issues

• Arterial line blood pressure monitoring
  
• Intravenous (IV) antibiotics (oxacillin 2 g or vancomycin 1 g for adults) should be given 30 minutes prior to incision
  
• Dexamethasone 10 mg IV preoperatively
  
• Anticonvulsant medication

Incision