# Combined exoscopic and endoscopic oblique approach to parafalx lesions while preserving normal structures via the interhemispheric fissure: How I do it

## TL;DR

A new surgical technique combines exoscopic and endoscopic methods to safely access brain lesions near the falx while avoiding damage to critical structures.

## Contribution

The selective interhemispheric oblique approach (SIOA) introduces a novel surgical method for parafalx lesions using combined visualization and gravity-assisted retraction.

## Key findings

- The SIOA technique reduces risks of venous injury and frontal sinus damage.
- Gravity-assisted retraction improves access to complex anatomical areas.
- The method avoids retraction of eloquent brain regions and achieves good outcomes.

## Abstract

When treating parafalx lesions, the bridging veins or the frontal sinuses can sometimes obstruct access. Preserving these structures to avoid surgical complications is preferred.

We described the concept of the selective interhemispheric oblique approach (SIOA), which combines exoscopic and endoscopic visualization with gravity-assisted brain retraction to ensure safe access to the parafalx lesions.

The SIOA is a precise and versatile technique for treating parafalx lesions, particularly in anatomically complex areas. With this approach, it’s possible to mitigate risk of venous injury or sinus opening, avoid the retraction of eloquent areas, and obtain excellent surgical outcomes.

The online version contains supplementary material available at 10.1007/s00701-025-06529-0.