Dr. Rao pitches cylinder surgery as safer option for deep brain lesions

At NSIPPFCON 2026 in Bengaluru, neurosurgeon Dr. Mohana Rao Patibandla outlined a white matter-sparing approach called cylinder surgery for selected deep brain lesions. The pitch centers on reducing surgical injury, protecting neurological function and improving recovery through better imaging and precision tools.

Why it matters: - Deep-seated brain lesions often require surgeons to cross healthy tissue to reach the target, which raises the risk of neurological injury. - Dr. Rao framed cylinder surgery as a shift toward preserving white matter pathways, not just removing the lesion. - The approach is aimed at lowering complications and protecting function in carefully selected patients.

What happened: - Dr. Mohana Rao Patibandla presented an invited lecture at the First National Meeting on Complications in Neurosciences, or NSIPPFCON 2026. - The talk, titled "Complication Avoidance in Deep-Seated Lesions: Current Concepts in a White Matter Sparing Paradigm," was delivered in the tumors and cranioplasty scientific session at the NIMHANS Convention Centre in Bengaluru. - The conference was organized under the auspices of the Neurological Society of India and the Private Practitioners Forum. - Dr. Rao is an internationally fellowship-trained neurosurgeon and founder and chairman of Dr. Rao's Hospital – International Institute of Neurosciences in Guntur, Andhra Pradesh.

The details: - Cylinder surgery is also known internationally as parafascicular tubular retractor surgery or neuroendoport-assisted surgery. - The technique uses a carefully planned cylindrical corridor to separate white matter fibers along their natural orientation. - The goal is to reduce collateral injury while maintaining visualization of deep lesions. - Dr. Rao said modern planning now often combines diffusion tensor imaging tractography, connectome-based surgical planning, neuronavigation, tubular retractors, high-definition operative microscopy, neuroendoscopy, intraoperative neurophysiological monitoring and advanced microsurgical instruments. - He said those tools help surgeons identify the safest corridor and limit disruption of healthy brain tissue. - The approach is used for selected patients with deep-seated gliomas, brain metastases, thalamic tumors, basal ganglia lesions, intraventricular tumors, colloid cysts, cavernous malformations, selected epilepsy-associated lesions and deep intracerebral hemorrhages. - The technique uses a narrow working channel to reach deep pathology through natural anatomical corridors when feasible. - Dr. Rao said complication avoidance starts before surgery with patient selection, detailed MRI review, functional imaging when needed, DTI tractography, connectomic analysis, trans-sulcal entry planning, neuronavigation, gravity-assisted positioning, continuous monitoring and meticulous microsurgical technique. - The presentation said treatment decisions remain individualized based on lesion type, location, size, nearby eloquent structures and the patient’s overall condition. - Dr. Rao's Hospital – International Institute of Neurosciences has invested in neuronavigation, intraoperative neurophysiological monitoring, high-definition microscopy, endoscopy and minimally invasive surgical platforms.

Between the lines: - The lecture reflects a broader move in neurosurgery from maximal access to maximal preservation. - The emphasis on connectomics and tractography signals a more map-driven approach to surgery, where protecting neural networks can be as important as removing the lesion. - The reported benefits of minimally invasive tissue-preserving surgery include less brain injury, smaller craniotomies, less brain retraction, faster recovery, shorter hospitalization, earlier rehabilitation and fewer neurological deficits in appropriately selected cases. - Dr. Rao's comment that the future of deep brain surgery is defined by how much normal brain is preserved underscores that functional outcome is becoming a central measure of success.

What's next: - Cylinder surgery and other white matter-sparing methods are likely to continue spreading for selected deep brain cases as imaging, navigation and monitoring tools improve. - Dr. Rao said the next step for surgeons is to match the technique to the right lesion, anatomy and patient profile rather than use a one-size-fits-all approach. - The conference's focus on complication prevention suggests more emphasis on preoperative planning and intraoperative safeguards in neurosurgical training and practice.

The bottom line: - Cylinder surgery is being positioned as a precision neurosurgery strategy that aims to reach deep brain lesions while protecting the brain’s wiring and preserving function.