MIPS concepts · Fictional teaching exercise
One target, two corridors.
Minimally invasive parafascicular surgery brings the access corridor into the anatomical discussion. Explore two illustrative trajectories to a shared target, then explain what changes between them.
Loading reference anatomy…
LEFT HEMISPHERE- FAT
- CST
- SLF I
Drag to rotate, pinch or scroll to zoom. With the canvas focused, use arrow keys to rotate, Shift + arrows to pan, + / − to zoom, and Home to reset.
A and B are abstract access volumes. Their entry points do not identify a sulcus. Apparent overlap or separation is not a measurement of fibre injury or clearance.
01 / Locate the relationships
Start with the target.
Find the sphere from the lateral, superior and anterior views. Follow the neighbouring pathways through depth.
- What seems adjacent in one view but separates when you rotate?
- Which relationships remain hard to judge from these sampled streamlines?
A projected crossing on screen does not establish a three-dimensional intersection.
02 / Change the access volume
Same target. Different relationships.
A enters from an anterolateral point; B from a superior point. Inspect each separately, then together.
- How does each axis relate to the local direction of the displayed pathways?
- What changes when the volume widens while the axis stays fixed?
- What would you need to know about entry anatomy and working angles before interpreting the comparison?
03 / Make the uncertainty explicit
Defend your reasoning.
Describe one trade-off between A and B, one limitation of this atlas, and one piece of evidence that could change your interpretation.
There is no preferred corridor supplied by this exercise.
Kept in this page only. Reloading clears your notes. Use fictional reasoning; do not enter patient information.
Compare with discussion prompts
- Entry: a surface point does not describe sulcal vessels, veins or short association fibres.
- Volume: the same axis can enclose a different amount of space when its width changes. This display does not simulate strain or displacement.
- Orientation: following a displayed bundle direction does not prove an access route preserves function.
- Dynamics: preoperative reference geometry cannot represent brain shift or the evolving operative field.
Revisit your account: did you separate an observation from an inference, name missing anatomy, and say what could change your view?
A framework for discussion
Think beyond the centreline.
The five-point framework connects surface access with the target and intended margins. Its terms are listed from surface to depth; planning starts with the target.
- Craniotomy
- The opening considered in relation to both corridors and the intended range of access.
- Outer radial corridor
- The cortical or sulcal entry geometry.
- Inner radial corridor
- The white-matter path and cannulation axis.
- Target
- Lesion characteristics and vascular relationships, which this fictional sphere does not supply.
- Resection margins
- A planned boundary requiring intraoperative functional information. No margins are defined here.
Educational draft awaiting independent clinical review. No patient registration, navigation, clearance calculation or recommendation of an operative route.
Evidence and limits
MIPS planning framework (Lavrador et al., 2026)
The framework organizes a discussion; it has not established improved oncological or functional outcomes and does not validate these authored coordinates.
ENRICH trial (Pradilla et al., 2024)
Randomized evidence in selected intracerebral haemorrhage, with benefit appearing attributable to lobar cases. It cannot be treated as proof of benefit for tumour surgery.
Atlas provenance and sampling limits
Displayed streamlines are sampled reference reconstructions. Missing fibres and vessels remain unknown here.