The Intraoperative Golden Hour in Minimally Invasive Parafascicular Surgery for Brain Tumors.

Area of Science:

• Neurosurgery
• Minimally Invasive Techniques
• Neuro-oncology

Background:

• Deep-seated brain tumors pose significant surgical challenges.
• Traditional approaches often limit resections to biopsy or medical management.
• Minimally invasive parafascicular surgery (MIPS) enables function-sparing resections.

Purpose of the Study:

• To introduce and detail the structured frameworks for Minimally Invasive Parafascicular Surgery (MIPS).
• To outline the six-pillar concept and five-point target-trajectory complex planning.
• To emphasize the importance of the intraoperative golden hour for successful MIPS.

Main Methods:

• Integration of advanced neuroimaging and tractography for preoperative planning.
• Utilization of tubular retractor systems for atraumatic access.
• Application of fluorescence-guided resection and neuromonitoring during surgery.
• Detailed five-point target-trajectory complex planning (craniotomy, corridors, target, margins).

Main Results:

• The six-pillar concept provides a comprehensive approach to MIPS.
• Five-point target-trajectory planning translates imaging into precise surgical routes.
• Management of the intraoperative golden hour is critical for minimizing access injury.
• Successful MIPS balances maximal tumor resection with minimal disruption of eloquent brain structures.

Conclusions:

• MIPS, guided by structured planning frameworks, represents a paradigm shift in treating deep-seated brain tumors.
• The six-pillar concept and five-point target-trajectory planning are foundational to MIPS.
• Careful navigation of the intraoperative golden hour is essential for optimal functional outcomes in MIPS.