[Effective Use of Evolutionary Operating Room]

Brain parenchyma tumors, typically gliomas, often arise in eloquent areas and complex regions deep within the brain that are involved in language, motor, and higher cognitive functions. Brain tumor surgery aims to safely remove as much of the tumor as possible while preserving brain function. However, invasive brain tumors, such as gliomas, are often difficult to distinguish from the normal brain, and removal of the entire tumor may inadvertently damage the normal brain tissue, resulting in the risk of serious postoperative complications. Additionally, brain tissue is subject to brain deformation, called brain shift, because of cerebrospinal fluid drainage and tumor removal. This reduces the accuracy of neuronavigation during preoperative planning, resulting in differences in the exact locations of the tumor and nerve fibers. Intraoperative magnetic resonance imaging (MRI) enabled to identify the exact tumor position and residual tumor in real-time perioperatively, compared to surgery that relies on the surgeon's experience and skill, enabling highly accurate surgery. Moreover, the fusion and comparison of preoperative images and latest intraoperative MRI images enable the accurate evaluation of tumor location and safe tumor removal. Intraoperative MRI imaging-assisted techniques that can capture residual tumor morphology and awake surgery that preserves brain function should be integrated to complement each other's roles.