Minimally Invasive Parafascicular Surgery (MIPS) for Primary and Metastatic Brain Neoplasms

Abstract

Neoplastic lesions arising in the subcortical space can present a daunting challenge to the neurosurgical team. Optimizing surgical exposure while minimizing the risk of significant collateral damage to critical white matter tracts and other structures is often difficult when employing classic microneurosurgical concepts. This chapter focuses on the current state of development in minimally invasive parafascicular surgery (MIPS) as applied to subcortical neoplasms. Application of advanced imaging technology, computerized image guidance platforms, enhanced digital optics, and miniaturized mechanical instrumentation to work through a small port allows precise resection of lesions deep in the brain, avoiding significant interruption of critical white matter tracts. The indications, planning, and execution of the MIPS technique in subcortical tumor surgery are outlined, including lessons learned by the author as experience has accumulated with MIPS.