Lavrador, José Pedro Wroe-Wright, Oliver Marchi, Francesco Elhag, Ali O’Keeffe, Andrew De la Fuente, Pablo Soumpasis, Christos Cardia, Andrea Mirallave-Pescador, Ana Díaz-Baamonde, Alba Sadio Mosquera, Jose Coiteiro, Domingos Jewell, Sharon Strong, Anthony J Gullan, Richard Ashkan, Keyoumars Vergani, Francesco Kailaya Vasan, Ahilan Bhangoo, Ranjeev 2025 Background: The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown. Methods: This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System©). All patients underwent pre- and post-cannulation indocyanine green study using a FLOW 800 module in a KINEVO Zeiss© microscope. Speed, delay, time-to-peak (TtP) rise-in-time and cerebral blood flow index (CBFI) metrics were assessed. Results: Thirty-five patients were included, with 144 regions-of-interest (ROIs) selected. The majority of patients were diagnosed with glioblastoma (51.43%), and 37.14% of patients had a preoperative focal neurological deficit (FND) at presentation. A ROI-based analysis concluded that an increase in speed and CBFI was related with a worse neurological outcome when comparing the pre- and post-brain cannulation assessments (speed: deterioration = 43.12 ± 80.60% versus stable = −14.51 ± 57.80% versus improvement = 6.93 ± 31.33%, p < 0.0001; CBFI: deterioration = 50.40 ± 88.17% versus stable = −2.70 ± 67.54% versus improvement = −38.98 ± 26.17%, p = 0.0005). These findings were reproducible in a combined-ROI per patient analysis and confirmed after adjustment for confounding. Conclusion: Microvascular flow dynamics impact trMIPS outcomes as an increase in the speed and CBFI after decannulation was related with worse neurological outcome. application/pdf https://n2t.net/ark:/12658/srd1332214 https://susi.usi.ch/global/documents/332214 https://susi.usi.ch/documents/332214/files/Marchi_2025_MDPI_cancers_Microvascular cortical dynamics.pdf eng info:eu-repo/semantics/altIdentifier/doi/10.3390/cancers17091392 info:eu-repo/semantics/altIdentifier/ark/12658/srd1332214 info:eu-repo/semantics/openAccess CC BY Cancers. - 2025, vol. 17, no. 9, p. 1392 Transsulcal approach Minimal invasive parafascicular surgery Neuro-oncology Tubular retractor Microvascularization Deep-seated lesions info:eu-repo/classification/udc/61 Microvascular cortical dynamics in minimal invasive deep-seated brain tumour surgery http://purl.org/coar/resource_type/c_6501