Image-Guided Neurosurgery

Imaging is critical in guiding neurosurgery since the target is often hidden, difficult to reach, and surrounded by anatomically and functionally critical tissue. Image-guided neurosurgery integrates various imaging techniques during preplanning, execution, and postoperative assessment of neurosurgical procedures, each offering substantial advantages while facing specific limitations. Neuronavigation facilitates intra-operative orientation but is limited by the “brain-shift” phenomenon. Intraoperative MRI provides the most accurate imaging for verifying and enhancing the extent of resection (EOR), though it is extremely costly and time-consuming. Intraoperative CT is faster, less expensive, and beneficial for spine surgery and interventional procedures, although it is less detailed for soft tissues. Intraoperative ultrasound is cost-effective and rapid but requires significant expertise to interpret images. Intraoperative fluorescence enables direct visualization of tumors, though it may produce false positives and negatives. 3D virtual reality aids in detailed preplanning, potentially reducing operative time and disorientation while enhancing effectiveness and safety at a lower cost. Combining multiple imaging modalities and integrating advanced physiological and functional imaging into surgical planning and execution compensates for individual limitations, providing optimal safety and EOR outcomes.