Background: Subcortical injury resulting from the surgical access and management of lesions in the sensorimotor area is associated with a high degree of cognitive and functional morbidity. Methods: We used a systems approach integrating the six core competencies of the 6 Pillar approach: 1) image interpretation and trajectory planning; 2) dynamic navigation; 3) radial transulcal access and cannulation; 4) exoscopic high-definition optics; 5) resection with automated nonthermal mechanical instrumentation; and 6) regenerative medicine. We describe the application of the 6 Pillar approach to 13 consecutive patients with lesions in the sensorimotor area. Results: Eight females and five males with lesions in the sensorimotor area were treated using the 6 Pillar approach. There were eight tumors, one abscess, and four primary intracranial hemorrhages. Fifteen procedures were performed. Postoperatively, seven patients improved neurologically (three tumors, one abscess, and three ICHs), five remained unchanged, and one patient died. There was no worsening of pre-existing deficits. Conclusion: The integration of the 6 Pillar approach provides a safe and effective parafascicular minimally invasive corridor to subcortical lesions involving the sensorimotor area. Future studies will be needed to determine long-term efficacy, durability, and degree of resection within each category.
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