Neurosurgical.tv AI™ DeepZoom™ Clinical Relevance Analysis

The MOSAIC Approach: A New Multi-Corridor Strategy for the Anterolateral Skull Base

Original Presenter

Iype Cherian

CR-AI™ Clinical Relevance

⭐⭐⭐⭐⭐ (5/5)

Potential Impact: High

The MOSAIC Approach represents a conceptual evolution in skull base surgery by integrating several minimally invasive surgical corridors into a flexible, patient-specific strategy rather than relying on a single operative route. Instead of asking, “Which approach should I choose?”, the MOSAIC philosophy asks, “Which combination of minimally invasive corridors provides the safest visualization for this individual patient?”

This shift reflects the growing trend toward customized surgical planning using multiple complementary access routes.

AI™ DeepZoom Analysis

Why This Matters

For decades, neurosurgeons have developed increasingly sophisticated approaches to the anterolateral skull base, including:

Pterional

Supraorbital (“eyebrow”)

Dolenc transcavernous

Kawase anterior petrosectomy

Endoscopic endonasal

Transorbital endoscopic

MIPLATTA

Each provides excellent exposure—but each also has limitations.

The MOSAIC concept recognizes that no single approach provides optimal visualization of every anatomical region or pathology.

Rather than expanding a single exposure, the surgeon combines several smaller, complementary corridors.

The MOSAIC Philosophy

Instead of maximizing one operative window, the surgeon creates:

Multiple viewing angles

Multiple working trajectories

Smaller operative corridors

Less tissue disruption

Better illumination

Improved depth perception

Enhanced visualization around neurovascular structures

The result is a more adaptable strategy that can be individualized for each patient’s anatomy.

Why AI Finds This Important

Modern artificial intelligence increasingly supports preoperative planning by integrating:

High-resolution MRI

CT angiography

Diffusion tractography

3D vascular reconstruction

Bone anatomy

Cranial nerve pathways

AI can simulate numerous surgical trajectories before entering the operating room.

The MOSAIC philosophy aligns naturally with these technologies because it encourages selecting the optimal combination of corridors rather than committing to a single fixed approach.

Future AI systems may automatically recommend personalized corridor combinations based on lesion location, vascular anatomy, cranial nerve relationships, and anticipated surgical risk.

Advantages of the MOSAIC Concept

Smaller Exposure

A single eyebrow incision may provide access to several operative corridors while reducing soft tissue trauma.

Multiple Perspectives

Viewing pathology from different angles can improve understanding of complex three-dimensional anatomy.

Tailored Surgery

Corridors can be selected according to:

Tumor size

Aneurysm orientation

Cranial nerve displacement

Vascular anatomy

Bone anatomy

Compatibility with Modern Technology

The approach integrates well with:

Exoscopes

Articulating endoscopes

Neuronavigation

Intraoperative imaging

Three-dimensional visualization

Potential Applications

The MOSAIC approach may prove useful for selected:

Anterolateral skull base tumors

Parasellar lesions

Cavernous sinus pathology

Petroclival lesions

Basilar apex aneurysms

Superior cerebellar artery aneurysms

Selected vascular lesions around the upper brainstem

Appropriate patient selection and surgeon experience remain essential.

Future Directions

The cadaveric work being evaluated combines:

High-definition exoscopes

Articulating endoscopy

Microsurgical dissection

Dynamic viewing angles

Future developments may include:

AI-guided trajectory planning

Augmented reality overlays

Virtual reality rehearsal

Robotic endoscope positioning

Digital surgical twins

Automated anatomical recognition

Machine learning–assisted corridor optimization

DeepZoom™ Take-Home Message

The MOSAIC Approach is more than another skull base operation—it is a shift toward modular, patient-specific neurosurgery. By combining minimally invasive corridors such as the supraorbital, transorbital transcavernous, and endonasal routes, surgeons can obtain complementary perspectives while limiting tissue disruption.

As AI-powered planning, advanced visualization, exoscopes, articulating endoscopes, and augmented reality continue to mature, strategies like MOSAIC may become increasingly practical, enabling safer and more individualized treatment of complex skull base and cerebrovascular pathology.