{"id":"51c91f73-52b8-41a0-bcff-fead54c60e82","slug":"transsulcal-parafascicular-brain-path-assisted-approach-to-subcortical-lesions-2-dimensional-operative-video","title":"Transsulcal parafascicular brain path-assisted approach to subcortical lesions: 2-dimensional operative video","authors":["Robert Charles Rennert","Medhi Khani","Kevin Thomas","Thomas W. Morris","Analiz Rodriguez","J. D. Day"],"abstract":"Background: Approaches to subcortical lesions have traditionally been limited by the morbidity of white matter dissection and fixed blade retraction required to reach these targets. Visualization of deep surgical fields with a traditional operating microscope is also poor. Coordinated use of intra-operative image guidance, a tubular retractor (BrainPath®, Nico Corp, Indianapolis, Indiana), a high-definition exoscope (Vitom®, Karl Storz Endoscopy America, Inc, El Segundo, California), and a low-profile resection device (Myriad®, Nico Corp) facilitates atraumatic access to and resection of subcortical lesions including primary brain tumors, brain metastases, and intracerebral hemorrhages.[1] Use of pre-planned transsulcal and parafascicular trajectories based on magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) can further mitigate damage to white matter tracts with this technique. Case Description: We herein present details of the transsulcal parafascicular BrainPath®-assisted approach to subcortical lesions and demonstrate the utility of this technique using two patient examples: a spontaneous deep left posterior temporal lobe hematoma in a 41-year-old male and a left hippocampal glioblastoma in a 54-year-old female. Key steps include selection of appropriate patients with non-skull base subcortical lesions, preoperative trajectory and tube depth planning based on MRI (including diffusion-weighted imaging and DTI), patient positioning and operating room setup to facilitate pre-planned trajectories and surgeon ergonomics, and use of low-profile instruments with a two-handed surgical technique. Conclusion: Given recent data demonstrating the utility of this approach for hematoma evacuation and a likely increased future usage of this technique,[2] surgeon familiarity with the above steps will be of increasing importance. 0:11 - Key steps in the transsulcal parafascicular brain path-assisted approach. 1:57 - Patient example #1. 2:56 - Patient example #2. Patient’s consent not required as patients identity is not disclosed or compromised. There are no conflicts of interest.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/stereotactic.png","publishDate":"2021-03-17T00:00:00.000Z","doi":"10.25259/SNI_776_2020","categories":["Stereotactic","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/51c91f73-52b8-41a0-bcff-fead54c60e82/pdf"}