Advances in surgical approaches to supratentorial deep-seated lesions

Deep-seated lesions are lesions that can range from subcortical regions such as the insula to deeper targets such as the basal ganglia and thalamus. There are a multitude of options for treating these lesions depending on the pathology and surgical goals. Stereotactic needle biopsy is a useful technique if the goal is to obtain tissue for diagnosis. When the goal is for more aggressive debulking or resection of the lesion, there are multiple approaches including transsylvian, transcortical, or interhemispheric transcallosal routes. The focus of this chapter will include advances in approaches to deep-seated lesions including trans-sulcal approaches using tubular retractors and magnetic resonance-guided laser interstitial thermal therapy. Along with this, there will be a discussion of adjunct imaging techniques and intraoperative techniques, which assist in maximizing safety and extent of resection.