{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:29Z","timestamp":1787027669386,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Objective: The aim of this work is to define a methodological strategy for the minimally invasive tubular retractor (MITR) parafascicular transulcal approach (PTA) for the management of brain tumors sited in eloquent areas. Methods: An observational prospective study was designed to evaluate the benefits of PTA associated with MITRs, tractography and intraoperative cortical stimulation. They study was conducted from June 2018 to June 2021. Information regarding white matter tracts was processed, preventing a potential damage during the approach and\/or resection. All patients older than 18 years who had a single brain tumor lesion were included in the study. Patients with a preoperative Karnofsky Performance Scale (KPS) score greater than 70% and a Glasgow Coma Scale (GCS) score &gt; 14 points were included. Results: 72 patients were included in the study, the mean age was 49.6, the most affected gender was male, 12.5% presented aphasia, 11.1% presented paraphasia, 41.6% had motor deficit, 9.7% had an affection in the optic pathway, the most frequently affected region was the frontal lobe (26.3%), the most frequent lesions were high-grade gliomas (34.7%) and the measurement of the incisions was on average 5.58 cm. Of the patients, 94.4% underwent a total macroscopic resection and 90.2% did not present new postoperative neurological deficits. In all cases, a PTA was used. Conclusion: Tubular minimally invasive approaches (MIAs) allow one to perform maximal safe resection of brain tumors in eloquent areas, through small surgical corridors. Future comparative studies between traditional and minimally invasive techniques are required to further investigate the potential of these surgical nuances.<\/jats:p>","DOI":"10.3390\/brainsci13030498","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T03:14:35Z","timestamp":1678936475000},"page":"498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Standardization of Strategies to Perform a Parafascicular Tubular Approach for the Resection of Brain Tumors in Eloquent Areas"],"prefix":"10.3390","volume":"13","author":[{"given":"Nadin J.","family":"Abdala-Vargas","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San Jos\u00e9, Cra. 19 #8A-32, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1573-431X","authenticated-orcid":false,"given":"Giuseppe E.","family":"Umana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Trauma and Gamma-Knife Center Cannizzaro Hospital, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier G.","family":"Pati\u00f1o-Gomez","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San Jos\u00e9, Cra. 19 #8A-32, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1179-5825","authenticated-orcid":false,"given":"Edgar","family":"Ordo\u00f1ez-Rubiano","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San Jos\u00e9, Cra. 19 #8A-32, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hernando A.","family":"Cifuentes-Lobelo","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS), Hospital Infantil Universitario de San Jos\u00e9, Cra. 19 #8A-32, Bogot\u00e1 111221, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0711-3975","authenticated-orcid":false,"given":"Paolo","family":"Palmisciano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45220, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2305-5544","authenticated-orcid":false,"given":"Gianluca","family":"Ferini","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Viola","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Zagardo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, REM Radioterapia s.r.l., 95029 Vaigrande, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Casanova-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"San Felipe Campus, Medical Faculty, University of Valpara\u00edso, Valpara\u00edso 2170000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ottavio S.","family":"Tomasi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Campero","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Padilla Hospital, Tucum\u00e1n T4000, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9323-8306","authenticated-orcid":false,"given":"Matias","family":"Baldoncini","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, San Fernando Hospital, Buenos Aires B1646, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"81","DOI":"10.25259\/JCIS_176_2020","article-title":"An Illustrative Review of Common Modern Craniotomies","volume":"10","author":"Rao","year":"2020","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.nec.2010.07.001","article-title":"The Concept of Minimally Invasive Neurosurgery","volume":"21","author":"Teo","year":"2010","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S1042-3680(18)30070-6","article-title":"History of Ventriculostomy","volume":"12","author":"Walker","year":"2001","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"301","DOI":"10.3171\/jns.1988.69.2.0301","article-title":"The stereotaxic retractor in computer-assisted stereotaxic microsurgery","volume":"69","author":"Kelly","year":"1988","journal-title":"J. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00006123-198210000-00016","article-title":"The Supraorbital Approach: Technical Note","volume":"11","author":"Jane","year":"1982","journal-title":"Neurosurgery"},{"key":"ref_6","first-page":"242","article-title":"Ten-year Experience with the Supraorbital Subfrontal Approach through an Eyebrow Skin Incision","volume":"57","author":"Reisch","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"132","DOI":"10.3340\/jkns.2009.45.2.132","article-title":"Keyhole approaches in neurosurgery, Volume 1, Concept and surgical technique","volume":"45","author":"Perneczky","year":"2009","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1007\/s00701-013-1639-7","article-title":"Intraoperative low-field MR-guided frameless stereotactic biopsy for intracerebral lesions","volume":"155","author":"Burkhardt","year":"2013","journal-title":"Acta Neurochir."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.nec.2010.07.002","article-title":"Transcranial Minimally Invasive Neurosurgery for Tumors","volume":"21","author":"Garrett","year":"2010","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.jocn.2021.04.035","article-title":"Minimally-invasive tubular retraction ports for intracranial neurosurgery: History and future perspectives","volume":"89","author":"Larson","year":"2021","journal-title":"J. Clin. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1227\/NEU.0b013e3182274841","article-title":"Intraoperative high-field magnetic resonance imaging combined with fiber tract neu-ronavigation-guided resection of cerebral lesions involving optic radiation","volume":"69","author":"Sun","year":"2011","journal-title":"Neurosurgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1002\/jmri.24528","article-title":"Diffusion tensor imaging and tractography of the human language pathways: Moving into the clinical realm","volume":"40","author":"Muthusami","year":"2014","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1093\/neuros\/nyx324","article-title":"Transsulcal Parafascicular Surgery Using Brain Path\u00ae for Subcortical Lesions","volume":"64","author":"Day","year":"2017","journal-title":"Neurosurgery"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.21608\/mjcu.2020.118547","article-title":"Utility of Linear Scalp Incision in Various Cranial Surgeries","volume":"88","author":"Adawi","year":"2020","journal-title":"Med. J. Cairo Univ."},{"key":"ref_15","first-page":"532523","article-title":"Minicraniotomy for Standard Temporal Lobectomy: A Minimally Invasive Surgical Approach","volume":"2014","author":"Albloushi","year":"2014","journal-title":"Int. Sch. Res. Not."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3171\/2011.8.PEDS1131","article-title":"Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants\u2014A preliminary single-institution experience","volume":"8","author":"Klimo","year":"2011","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1007\/s11548-010-0529-1","article-title":"Neurosurgical craniotomy localization using a virtual reality planning system versus intraoperative image-guided navigation","volume":"6","author":"Stadie","year":"2011","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Luo, M., Frisken, S.F., Narasimhan, S., Clements, L.W., Thompson, R.C., Golby, A.J., and Miga, M.I. (2019, January 17\u201319). A comprehensive model-assisted brain shift correction approach in image-guided neurosurgery: A case study in brain swelling and subsequent sag after craniotomy. Proceedings of the Medical Imaging 2019: Image-Guided Procedures, Robotic Interventions, and Modeling, San Diego, CA, USA.","DOI":"10.1117\/12.2512763"},{"key":"ref_19","unstructured":"Monroy-Sosa, A., Chakravarthi, S.S., Epping, A., Fukui, M.B., Jennings, J., Rovin, R., and Kassam, A.B. (2021). Principles of Neurooncology, Springer."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"674","DOI":"10.2176\/nmc.ra.2016-0069","article-title":"Critical Neural Networks in Awake Surgery for Gliomas","volume":"56","author":"Kinoshita","year":"2016","journal-title":"Neurol. Med. Chir."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"877","DOI":"10.3171\/2015.10.JNS15740","article-title":"Brain mapping: A novel intraoperative neuropsychological approach","volume":"125","author":"Skrap","year":"2016","journal-title":"J. Neurosurg."},{"key":"ref_22","first-page":"334","article-title":"Stereotactic minimally invasive tubular retractor system for deep brain lesions","volume":"63","author":"Greenfield","year":"2008","journal-title":"Neurosurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"220","DOI":"10.4103\/sni.sni_62_18","article-title":"Combination of the tubular retractor and brain spatulas provides an adequate operative field in surgery for deep-seated lesions: Case series and technical note","volume":"9","author":"Kurozumi","year":"2018","journal-title":"Surg. Neurol. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"644198","DOI":"10.3389\/fneur.2021.644198","article-title":"Navigated Transcranial Magnetic Stimulation Motor Mapping Usefulness in the Surgical Management of Patients Affected by Brain Tumors in Eloquent Areas: A Systematic Review and Meta-Analysis","volume":"12","author":"Umana","year":"2021","journal-title":"Front. Neurol."},{"key":"ref_25","first-page":"542","article-title":"Navigated Transcranial Magnetic Stimulation for \u201cSomatotopic\u201d Tractography of the Corticospinal Tract","volume":"10","author":"Conti","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_26","first-page":"251","article-title":"Functional Reconstruction of Motor and Language Pathways Based on Navigated Transcranial Magnetic Stimulation and DTI Fiber Tracking for the Preoperative Planning of Low Grade Glioma Surgery: A New Tool for Preservation and Restoration of Eloquent Networks","volume":"124","author":"Raffa","year":"2017","journal-title":"Acta Neurochir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3171\/2019.3.JNS183411","article-title":"Surgical treatment of meningiomas located in the rolandic area: The role of navigated transcranial magnetic stimulation for preoperative planning, surgical strategy, and prediction of arachnoidal cleavage and motor outcome","volume":"133","author":"Raffa","year":"2019","journal-title":"J. Neurosurg."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/3\/498\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:56:08Z","timestamp":1760122568000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/3\/498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,15]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["brainsci13030498"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13030498","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,15]]}}}