The intraoperative golden hour in minimally invasive parafascicular surgery for brain tumors
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Authors
Lavrador, Jos� Pedro
Chowdhury, Yasir A.
Sinosi, Filippo Andrea
Marchi, Francesco
Prasad, Vindhya
Genel, Oktay
Mirallave-Pescador, Ana
Diaz-Baamonde, Alba
Gullan, Richard
Ashkan, Keyoumars
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Issue Date
2026
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Article
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Abstract
Minimally invasive parafascicular surgery (MIPS) represents a paradigm shift in the management of deep-seated brain tumors, enabling function-sparing resections previously limited to biopsy and/or medical therapy. Central to MIPS are structured frameworks guiding preoperative planning and intraoperative execution. The six-pillar concept-comprising imaging, navigation, atraumatic access, optics, resection, and postoperative care-provides a comprehensive approach to integrate advanced neuroimaging, tractography, tubular retractor systems, fluorescence-guided resection, and neuromonitoring to optimize functional outcomes. Five-point target-trajectory complex planning-craniotomy, outer radial corridor, inner radial corridor, target, and resection margins-translates preoperative imaging and functional mapping into a precise surgical trajectory, balancing maximal tumor resection with minimal disruption of eloquent brain structures. Preoperative assessment of tumor characteristics, vascular relationships, and cortical eloquence informs trajectory planning and intraoperative adjustments. A critical determinant of MIPS success is the
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Journal
Cancers
Volume
18
Issue
8