Operative Planning

• Review imaging (magnetic resonance imaging [MRI], selective spinal angiography)

Embolization

• Preoperative embolization with polyvinyl alcohol, coils, or balloons 1 day before surgery may facilitate resection by reducing blood flow
  
• Dexamethasone is given to reduce swelling after embolization

Routine Equipment

• Laminectomy instruments
  
• High-speed drill
  
• Microsurgical instruments

Special Equipment

• Consider neurophysiological monitoring for somatosensory evoked potentials and motor evoked potentials

Operating Room Set-up

• Open-frame spinal table or electric table with bolsters or Wilson frame
  
• Ensure ability to obtain anteroposterior and lateral radiographs to confirm operative levels
  
• Headlight
  
• Loupes (optional)
  
• Bipolar (irrigating and nonirrigating) and Bovie cautery
  
• Microscope with bridge

• General anesthesia
  
• Arterial line for blood pressure monitoring
  
• Intravenous antibiotics (cefazolin 2 g or vancomycin 1 g for adults) should be given 30 minutes prior to incision
  
• Minimize halogenated inhalational agents and nitrous oxide to optimize responses if performing neurophysiological monitoring