Combined exoscopic and endoscopic oblique approach to parafalx lesions while preserving normal structures via the interhemispheric fissure: How I do it.

BACKGROUND

When treating parafalx lesions, the bridging veins or the frontal sinuses can sometimes obstruct access. Preserving these structures to avoid surgical complications is preferred.

METHODS

We described the concept of the selective interhemispheric oblique approach (SIOA), which combines exoscopic and endoscopic visualization with gravity-assisted brain retraction to ensure safe access to the parafalx lesions.

CONCLUSIONS

The SIOA is a precise and versatile technique for treating parafalx lesions, particularly in anatomically complex areas. With this approach, it's possible to mitigate risk of venous injury or sinus opening, avoid the retraction of eloquent areas, and obtain excellent surgical outcomes.