Stereotactically Guided Microsurgical Approach for Deep-Seated Eloquently Located Lesions

Area of Science:

• Neurosurgery
• Medical Imaging
• Stereotactic Surgery

Background:

• Neuronavigation and intraoperative imaging improve resection of deep brain lesions.
• Brain shift poses a risk to critical brain tissue in eloquent regions.
• A stereotactically guided microsurgical approach with intraoperative CT (iCT) was investigated for deep-seated lesions.

Purpose of the Study:

• To analyze the feasibility and outcomes of a stereotactically guided microsurgical approach supported by iCT for deep-seated, eloquently located brain lesions.
• To evaluate the accuracy of trajectory planning and catheter placement using frame-based stereotaxy and iCT.
• To assess the extent of resection and neurological outcomes following the procedure.

Main Methods:

• A cohort of 12 patients with deep-seated, eloquently located lesions treated between March 2017 and April 2023 were included.
• Frame-based stereotaxy was used for trajectory planning and catheter placement, verified by iCT.
• Microsurgical resection was performed along the catheter trajectory with neurophysiological monitoring; postoperative MRI assessed resection extent.

Main Results:

• The implanted catheter precisely matched the preoperative trajectory in all cases, confirmed by fused iCT data.
• Complete resection was achieved in all 12 patients.
• One patient experienced transient hemiparesis and aphasia, which fully resolved; others showed neurological improvement or remained seizure-free.

Conclusions:

• A stereotactically guided microsurgical approach with iCT enables accurate intraoperative localization of deep-seated lesions.
• The technique demonstrated feasibility and safety, with no immediate procedure-related complications in this cohort.
• While promising, broader clinical efficacy conclusions are limited by the small sample size and non-comparative design.