This short video describes resection of a metastasis in the central lobule. This is a 58 year-old male with progressive left-sided hemiparesis, who was noted to have a metastatic lesion, within the central lobule, leading to a significant amount of edema. He subsequently underwent a right frontal parietal craniotomy using intra-operative image guidance. I made a small corticotomy over the pull of the tumor that came closest to the surface of the pia. Obviously, due to highly functional neural tissue in this area, minimal amount of brain transgression should be performed. Here you can see the surface of the metastasis. Next, I carefully disconnect the capsule of the metastasis from the surrounding brain tissue. You can see a very small opening. I stay right on the surface of the mass to minimize the risk of leaving some tumor behind. Here's the gliotic margin adherent to the surface of the tumor. Gentle mobilization of the brain provides adequate operative space for dissection at the periphery of the tumor. Here's another part of the capsule that's being disconnected. Now moving toward the inferior surface, or apex of the tumor, using the bipolar forceps like scissors to disconnect the adhesions and connections of the capsule to the surrounding peritumoral areas. Thrombin solution is used to achieve hemostasis, and the post-operative MRI in this case demonstrated complete removal of the mass, and this patient made a significant recovery of his preoperative deficits. Thank you.
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