The chapter explores the evolution and future of invasive monitoring in epilepsy surgery, emphasizing the impact of technological advancements and conceptual shifts. The goal of epilepsy neurosurgery is to enhance brain function by precisely targeting and removing malfunctioning brain areas. Due to the brain’s complexity, detailed and accurate information about each patient’s condition is vital. Invasive monitoring, a diagnostic procedure involving the placement of recording electrodes in the brain, provides critical data for crafting tailored surgical strategies. Historically, the use of invasive monitoring evolved with the development of electrocorticography (ECoG) and stereotactic electroencephalography (sEEG). Early implementations relied on ictal symptoms and non-invasive techniques such as EEG, but advancements in electrode placement, notably by Jean Talairach and subsequent pioneers, enabled precise localization of seizure onset zones (SOZ). The regional divide saw North America favoring subdural grids, while Europe preferred sEEG, leading to a revolution in epilepsy surgery practice. Currently, sEEG dominates due to its ability to record deep brain structures and offer comprehensive network analysis. This shift is bolstered by innovations such as robot-assisted stereotaxy and MRI-guided laser therapy. The chapter concludes by highlighting the potential future directions, including enhanced computational analysis, Bayesian approaches, and artificial intelligence, which promise to refine surgical planning and improve patient outcomes.

Neurological disorders are the leading cause of disability worldwide. Restoring function through the modulation of brain networks has been a cornerstone in the field of functional restoration. Deep brain stimulation (DBS) along with neuroprosthetics such as cochlear implants have significantly improved the quality of life for patients with functional restoration. However, there remains a large population of patients who cannot benefit from existing approved medical technologies. Brain–machine interfaces (BMI) show great promise in addressing the unmet need in diagnostic and functional needs for patients with neurological disorders and disabilities. To date, more humans have received clinical benefit from the Utah Array than from any other BMI, but this also had several limitations. Recent advances in BMI address these limitations, showing improvements in invasiveness, longevity, signal quality, and usability. This chapter provides an overview of BMI and discusses the evolving technology in the field of BMI, which provides a novel dimension to the existing neurosurgical armamentarium modulating neurological function beyond the conventional neurosurgical treatment.

The concept of Neurosurgery is arguably the oldest of surgical specialties. It has evolved in scope and sophistication in bursts over many centuries – driven by the available knowledge, technologies, needs, and the courage of practitioners to move the concept forward. Concurrently, the computer has become a unifying neurosurgical tool, allowing for enormous expansion of novel concepts of treatment accessible. In this sense, the “Neurosurgeon” of the future will be in constant evolution with such technology – adapting according to the environmental demands of a growing and multifaceted field. In this chapter, we explore the role of the Neurosurgeon today and what the future may hold.

Imaging has become essential to the field of neurosurgery and has evolved significantly since the invention of the X-ray in 1895. Following the introduction of the X-ray, imaging techniques including ventriculography, myelography, encephalography and angiography revolutionized the field of neurosurgery by allowing for the visualization of intracranial and spinous structures not visible by clinical examination. Significant continued rapid advancements and implementation of new imaging techniques have occurred since the introduction of cross-sectional imaging, including CT and conventional MRI techniques. In recent years, imaging has become increasingly more sophisticated with the advent of DTI, functional imaging, radiogenomics, high-field strength MRI, and glymphatic imaging. Though imaging is already essential for diagnosis, presurgical planning, intra-operative guidance, post-surgical guidance, and surveillance, the possibilities offered by new imaging techniques will likely make neuroimaging even more central to the care and management of neurosurgical patients in the future. Our chapter provides a brief review of the history of available techniques and advanced imaging methods.

Advances in molecular engineering, materials science, and other key fields has afforded the ability to bring newly minted nano-scale science to the bedside in all medical specialties, notwithstanding neurosurgery. Modern neurosurgery has implemented a handful of available nanotechnologies to enhance clinical practice. However, the current implementation of nanotechnology has barely scratched the surface of its widespread potential application in neurosurgery, neuroimaging and neuro-oncology. Most of the technology is still relegated to the laboratory, but many recent developments have made these technologies more clinically applicable. Nanoparticles are increasingly used for drug delivery across a wide variety of neurologic disorders, new radiographic contrast agents and in vivo cell labeling, and numerous enhancements in neurosurgical hardware, including batteries, microelectrodes, spinal instrumentation and endovascular equipment. We still have much to learn about the clinical use of these technologies and the upcoming hurdles, such as cost, that may still limit technology as they become ready for everyday use. The future of nanotechnology in neurosurgery is happening now and will bring incredibly exciting and impactful applications to patient care.

The chapter highlights the importance of precision, planning, and rehearsal in neurosurgery due to the brain’s intricate structure. Advances in technology, such as augmented reality (AR) and virtual reality (VR), have revolutionized surgical planning, training, and execution. These technologies offer detailed 3D visualizations and interactive simulations, allowing surgeons to practice and refine their skills in a controlled environment. VR systems enable customized patient-specific models, enhancing pre-operative planning and interdisciplinary collaboration. AR overlays digital information onto the real world, providing real-time guidance during surgeries. The integration of AI, haptic feedback, and robotics further improves precision and outcomes, potentially transforming neurosurgical procedures and training.

Laser interstitial thermal therapy (LITT) involves the utilization of laser light energy and its photothermal properties when interacting with tissue for the treatment of various pathologies via the induction of hyperthermia and coagulation. Current neurosurgical applications of LITT include treatment of metastatic in-field recurrence, primary brain tumors, epilepsy, movement disorders, psychiatric disorders, pain syndromes, and spine tumors. Here we explore the basic principles of LITT and its current applications within neurosurgery. We then discuss the potential directions in which LITT may progress as a treatment modality, both as a stand-alone procedure and in conjunction with other adjunct interventions.

Neurosurgery has always been at the forefront of adopting innovative technologies and this may easily be explained by the unique demands imposed on surgeons when operating in the brain and spine. Augmented reality (AR) has emerged as a promising technology in neurosurgery, aiming to link the digital and physical worlds to enhance clinical practice and education. This review explores the evolution of AR in neurosurgery, from a modest optical technology inception to a digitally enhanced plethora of mixed reality media, and how widespread adoption has been hindered by technical limitations. Various approaches to displaying AR as well as requirements for future-proof patient digital models are discussed. Challenges associated with updating models intra-operatively and the need for precise tracking of the physical environment are also reviewed. The chapter concludes with the authors’ vision for overcoming these technical hurdles, which will be essential for realizing the full potential of AR in neurosurgical practice.

The safe and effective delivery of neuroanaesthesia in children requires knowledge of normal development and neurophysiology. Preoperative assessment must pay particular attention to the symptoms and signs of raised intracranial pressure. The conduct of anaesthesia is influenced by the underlying pathology, the procedure being performed and the need for intraoperative neuromonitoring. Extreme vigilance is required in circumstances where venous air embolus (VAE) is a risk, and the provision of appropriate facilities is essential.

Obsessive-compulsive disorder (OCD) is a neurobehavioral condition that can lead to functional impairment and decreased quality of life. In this chapter, clinical presentation, diagnostic considerations, and pathophysiology of OCD are reviewed. An overview of the theoretical models of OCD are provided, and evidence-based treatments for OCD, specifically cognitive behavioral therapy (CBT) with exposure and response prevention (ERP), pharmacotherapy, and neurosurgery, are discussed. The chapter concludes with suggestions for future research directions.