O-ARM navigation in tubular retractor-assisted minimal invasive parafascicular approach: technical note

Trans-sulcal minimally invasive parafascicular surgery is an emerging technique to approach deep lesions with minimal brain retraction. Localization of the tubular retractor during surgery is critical, and intraoperative magnetic resonance imaging and neuronavigation present limitations. We describe the intraoperative use of O-Arm® coupled with pre-operative tractography to precisely localize the tubular retractor. With air acting as contrast, the tubular retractor was localized in three dimensions, without any additional disruption to white matter tracts or nearby vascular structures. We conclude that visualization of tubular retractor using an intraoperative computerized tomography scan is a safe and feasible adjunct in resection of deep lesions via a minimally invasive approach.