Introduction: Managing subcortical lesions in the sensorimotor area can be associated with high degree of morbidity. The challenges encountered while approaching such lesions fall into one of the following categories; mapping and imaging, access, visualization, and tumor resection.
Methods: To circumvent some of the challenges described above, we created a systematic approach integrating 5 core competencies: 1) Imaging and mapping, 2) Dynamic navigation, 3) Radial transulcul access, 4) Exoscopic high definition optics, and 5) Resection with automated atraumatic mechanical instrumentation. This approach was used to manage 11 consecutive patients with lesions in the sensorimotor area.
Results: Five tumors (4 primary and 1 metastatic), 1 abscess, and 4 primary intracranial hemorrhages were managed at the Ottawa Hospitals from 2011-2013 using the 5 pillars approach. Seventy percent of the patients showed significant improvement while the remaining did not develop any new neurological deficits. Clinical improvement correlated with white matter tract recovery on Diffusion Tensor Imaging (DTI). One patient developed a post-operative Deep Vein Thrombosis. There were no mortalities.
Conclusions: The integration of the 5 pillars provides a safe and effective parafasicular minimally invasive corridor for resecting subcortical lesions involving the sensorimotor area.
Patient Care: Improve patients' functional outcome and quality of life by using a safe and effective approach for the resection of lesions in eloquent areas with minimal collateral damage.
Learning Objectives: Understand how multiple new technologies can be used to systematically approach lesions in eloquent areas with minimal collateral damage.