Operative Planning

• Magnetic resonance imaging: with and without contrast images essential; recommend asking for acquisition of postcontrast images in all planes for operative planning
  
• Image guidance: often helps in localizing the tumor to plan the incision, bony opening, and dural incision
  
• Angiogram: some surgeons will embolize large meningiomas preoperatively to reduce intraoperative bleeding
  
• Blood: if the lesion is large or next to the sinus, type and cross the patient for at least 2 units of blood
  
• Steroids: consider preoperative administration if there is significant edema

Anesthetic Issues

• Central line is important for the parasagittal meningioma cases so that the anesthesiologist can address the potential for air embolism
  
• Peripheral intravenous needles should be large bore to allow rapid blood transfusions, if needed
  
• Antibiotics
  
• Mannitol (0.5 to 1.0 g/kg) for large cases

Equipment

• Craniotomy tray
  
• Mayfield head holder
  
• High-speed drill
  
• Ultrasonic aspirator
  
• Micro scope

Surgical Approach

Convexity