Image-guided neurosurgery and neuroanatomical mapping: Current trends and translational advances

Image-guided neurosurgery has come of age to represent a cornerstone in modern cranial and spine surgery, as it incorporates broad-based neuroimaging, navigation platforms, and functional mapping strategies in order to increase accuracy for each surgical procedure and improve patient outcomes. Incremental improvements with magnetic resonance imaging, diffusion tensor imaging, intraoperative ultrasonography, and functional imaging have facilitated real-time anatomical and functional visualization intraoperatively with a consequent reduction in inadvertent collateral tissue injury and an improved safety profile for complex neurosurgical procedures. Simultaneously, neuroanatomical mapping with cortical and subcortical stimulation, tractography-based pathway delineation, and electrophysiological monitoring have further enhanced the fidelity of lesion localization and preservation of eloquent cortices. The emerging innovations, including augmented reality overlays, machine learning-driven segmentations, and hybrid intraoperative imaging systems, are now driving the field toward seamless integration across multiple modalities and personalized operative planning. This review synthesizes current trends in image-guided neurosurgery, examines the evolving role of neuroanatomical mapping in surgical decision-making, and highlights translational advances that reshape the landscape of precision neurosurgery.