Transsulcal parafascicular approach for resection of a brain metastasis using a syringe-based tubular system: a technical video demonstration

Minimally invasive transsulcal parafascicular approaches have gained increasing adoption for the resection of deep-seated brain lesions, allowing access corridors that spare eloquent white-matter tracts. Commercial tubular retractor systems can be costly and variably available, especially in resource-limited settings. This video article demonstrates a pragmatic, low-cost technique using a syringe-based tubular retractor system to safely access and resect a deep brain metastasis through a parafascicular corridor. A patient with a subcortical frontal brain metastasis underwent resection using a transsulcal parafascicular approach. A series of sterile medical syringes were modified to create a rigid tubular working channel mimicking standard expandable brain tubes. Neuronavigation was used to delineate the safest transsulcal entry point and define a trajectory parallel to critical white-matter pathways. The tubular system was introduced under microscopic visualization, allowing for minimally disruptive access. Standard microsurgical techniques were employed for circumferential tumor en bloc removal. The syringe-based tubular retractor provided effective circumferential support, maintained a stable operative corridor, and minimized cortical and subcortical retraction. The lesion was successfully resected without injury to adjacent eloquent structures. There was no intraoperative complication, and the patient showed stable postoperative neurological status. The video highlights key technical nuances, construction of the syringe-based tube, trajectory planning, and strategies to protect parafascicular tracts. This video illustrates a cost-effective adaptation of the transsulcal parafascicular approach using a simple syringe-constructed tubular retractor system. The technique offers a viable alternative in settings where commercial brain-tubular systems are limited, while maintaining the fundamental principles of minimally invasive corridor surgery.