Minimally Invasive Parafascicular Surgery for Resection of Cerebral Cavernous Malformations Utilizing Image-Guided BrainPath System.

Abstract

The minimally invasive parafascicular approach provides a surgical corridor to reach deep lesions with minimal impact on the surrounding brain tissue. To evaluate the safety and efficacy of this approach utilizing the image-guided tubular BrainPath system (NICO Corp, Indianapolis, Indiana) for the resection of deep and subcortical supratentorial cerebral cavernous malformations (CCMs). We performed a retrospective analysis of patients who presented with subcortical CCMs treated with the BrainPath system. Patient demographics, clinical presentation, procedural complications, and clinical and imaging follow-up information were assessed. Six patients were identified between December 2014 and November 2017 at a large volume academic institution in the United States. There were 3 males and 3 female patients with a median age of 25 yr. Locations included frontal, temporal, and parietal lobes. In selected cases, the fiber-sparing trajectory imposed a longer approach than the closest distance to the brain surface. Except for 1 patient who suffered from surgical wound dehiscence, there were no operative complications in any of the cases. All patients remained neurologically stable postoperatively with a mean follow-up of 20 moh. This small series suggests that the use of a minimally invasive surgical approach to CCMs utilizing the image-guided parafascicular tubular BrainPath system is feasible, safe, and effective.