In the field of neuro-oncological surgery, the evolution and integration of cutting-edge intraoperative imaging technologies are pivotal in advancing the precision and safety of tumor resections. The shift from traditional gross total resection of contrast-enhancing tumor portions to supramaximal resections, as per RANO classifications, highlights the critical need for high-resolution, real-time imaging modalities. These modalities are essential for accurately delineating both contrast-enhancing and non-enhancing tumor tissues, thereby improving surgical outcomes.

Recent developments have introduced several novel intraoperative tools such as hyperspectral imaging (HSI) and fluorescence-guided surgical instruments. Despite the prominence of 5-aminolevulinic acid (5-ALA) and intraoperative MRI in the field, each of these modalities has unique advantages and limitations in accurately identifying tumor margins and compensating for brain shift, particularly in eloquent brain areas. While intraoperative MRI demonstrates efficacy in achieving high rates of total resection without compromising neurological function, its cost and infrastructure demands pose challenges. HSI, on the other hand, offers a promising dye-free, contact-free, and potentially cost-effective alternative, especially potent when combined with machine learning approaches, in distinguishing infiltrative, non-enhancing glioma components.

This Research Topic seeks to consolidate existing evidence and delve into emerging intraoperative imaging modalities that bolster precision neurosurgery. It aims to assess their diagnostic accuracy, surgical efficacy, impact on progression-free and overall survival, alongside their integration into surgical workflows and cost-effectiveness.

To gather further insights in the realm of precision-guided neuro-oncological surgery, we welcome articles addressing, but not limited to, the following themes:

- Clinical trials or cohort studies on novel imaging modalities in brain tumor surgery
- Comparative analyses of iMRI, HSI, 5-ALA, and AR-assisted surgeries
Integration of intraoperative imaging with artificial intelligence and machine learning
- Technical notes on hardware integration or workflow optimization
Cost-effectiveness and accessibility studies in diverse healthcare settings
- Investigations into imaging modalities for supramaximal (RANO class 1) glioma resections
- Multi-modal imaging strategies in eloquent brain areas
- Case series on innovative clinical applications or imaging-based decision support

We aim to foster a multidisciplinary dialogue and showcase innovations that can redefine intraoperative guidance in neuro-oncology, ultimately leading to improved oncological and functional outcomes.

Are you interested in contributing a manuscript to this Research Topic?

Novel Intraoperative Imaging Modalities in Neuro-Oncological Surgery: Towards Precision-Guided Resections