The impact of new imaging technologies in neurosurgery

Neurosurgery has primarily been concerned with resective or ablative techniques for the accurate removal of pathological tissue with the minimal disruption of surrounding healthy neuronal matter. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve this aim including the development of microsurgical, endoscopic and endovascular techniques. Functional neurosurgery has also seen a particular resurgence over the last 15 years with the identification of new anatomical targets and clinical indications. Technological advances in neuroimaging are providing many new adjuncts to the neurosurgeon's armamentarium. Neuronavigation systems and intra-operative imaging have improved success in surgical removal of tumours from the central nervous system. Accurate epilepsy surgery requires imaging of the epileptogenic zone and accurate identification of adjacent eloquent cortex. New imaging modalities such as PET, SPECT, and fMRI can now be used in order to reduce neurological deficits resulting from surgery. This review highlights some of the major advances in neurosurgery and discusses the impact of neuronavigation and functional imaging in tumour surgery and epilepsy surgery.