We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Transsulcal parafascicular brain path-assisted approach to subcortical lesions: 2-dimensional operative video.
- Authors
Rennert, Robert Charles; Khani, Medhi; Thomas, Kevin; Morris, Thomas W.; Rodriguez, Analiz; Day, J. D.
- 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.
- Subjects
EL Segundo (Calif.); INDIANAPOLIS (Ind.); BRAIN tumors; MAGNETIC resonance imaging; DIFFUSION tensor imaging; DIFFUSION magnetic resonance imaging; WHITE matter (Nerve tissue); SURGICAL instruments
- Publication
Surgical Neurology International, 2021, Vol 12, p1
- ISSN
2229-5097
- Publication type
Article
- DOI
10.25259/SNI_776_2020