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Intraoperative Neuroimaging in Neurosurgery

A photo of Dr Colum Nolan, Senior Consultant Neurosurgeon of Oxford Spine & Neurosurgery Centre

Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Modern neurosurgery places strong emphasis on accuracy and adaptability, especially when operating close to the spinal cord and nerve structures. Intraoperative neuroimaging is one of the technologies used to support this approach. Unlike scans performed before surgery, intraoperative imaging allows updated images to be obtained during the operation itself, providing surgeons with real-time anatomical information.

Spine navigation and intraoperative neuroimaging are complementary technologies used in modern neurosurgery, each serving a different role during surgery. Spine navigation helps guide instruments based on mapped anatomy, while intraoperative neuroimaging provides updated images during the procedure to confirm progress and support decision-making. When used appropriately, they work together to support precision and safety during selected spine surgeries.

This page explains what intraoperative neuroimaging involves, how it is used in spine surgery, and how it supports selected treatments offered at Oxford Spine and Neurosurgery Centre.

What Intraoperative Neuroimaging Means

Intraoperative neuroimaging refers to the use of imaging tools such as intraoperative CT or MRI during surgery. These scans provide real-time or near real-time images of the spine after surgical steps have been performed.
This allows the surgical team to:
  • Reassess spinal anatomy during the operation
  • Confirm the extent of nerve decompression
  • Verify alignment or implant positioning before completing surgery
Intraoperative imaging recognises that anatomy can shift once surgery begins, and updated images help guide careful decision-making at key stages.

Why Real-time Imaging Matters During Spine Surgery

During spine surgery, changes such as tissue movement, fluid shifts, or patient positioning can alter anatomical relationships. Images taken before surgery may no longer fully reflect what is occurring during the operation.
Medical studies have shown that intraoperative imaging may:
  • Improve confirmation of surgical targets
  • Reduce uncertainty in complex or revision procedures
  • Support more complete decompression in selected cases
This additional visual feedback supports surgical judgement rather than replacing it.

How Intraoperative Neuroimaging Is Used in Spine Surgery

In spine surgery, intraoperative neuroimaging is often used together with navigation systems to provide updated reference points.

 

It may support procedures involving:

Updated imaging allows surgeons to confirm key objectives before the procedure is completed.

Role in Minimally Invasive Spine Surgery

Minimally invasive spine surgery relies on smaller access points and indirect visualisation. Intraoperative neuroimaging helps compensate for this by providing internal confirmation without extending surgical exposure.
When used appropriately, it may help to:
  • Confirm adequate nerve decompression
  • Support accurate placement of instruments or implants
  • Reduce reliance on repeated fluoroscopy
This supports precision while maintaining a tissue-sparing approach.

Sidebar: Understanding the Difference Between Spine Navigation and Intraoperative Neuroimaging

Spine navigation and intraoperative neuroimaging are often discussed together, but they support surgery in different ways.
Spine navigation is a guidance system. It uses mapped imaging to help surgeons plan and guide instrument placement with accuracy throughout the procedure.
Intraoperative neuroimaging provides updated images during surgery. It allows surgeons to reassess anatomy after key surgical steps and confirm changes before completing the operation.
In simple terms:
  • Spine navigation helps guide where instruments are placed
  • Intraoperative neuroimaging helps confirm what has been achieved
Both technologies may be used together in selected cases, depending on clinical needs and surgical complexity.

Experience and Clinical Use at Oxford Spine and Neurosurgery Centre

The effective use of intraoperative neuroimaging requires familiarity with both the technology and its integration into the surgical workflow.

At Oxford Spine and Neurosurgery Centre, intraoperative neuroimaging may be utilised where appropriate to support accuracy during neurosurgical spine procedures. Its use is guided by clinical assessment, imaging findings, and procedural requirements rather than as a routine step.

Dr Colum Nolan incorporates intraoperative imaging as part of a broader neurosurgical approach when updated visual information may add value during complex or delicate spine surgeries. This allows surgical planning to remain flexible and responsive to real-time findings.

Intraoperative Imaging as Part of a Broader Spine Care Pathway

While intraoperative neuroimaging supports the surgical phase, it forms only one part of comprehensive spine care. Treatment planning also includes:
  • Detailed clinical assessment
  • Correlation of symptoms with imaging findings
  • Consideration of non-surgical treatments, such as pain management or rehabilitation
Postoperative monitoring and recovery planning

Medical Disclaimer
This page is intended for general educational purposes only and does not constitute medical advice. Information provided is not a substitute for professional medical consultation, diagnosis, or treatment. The use of intraoperative neuroimaging depends on individual clinical assessment and suitability, as determined by a qualified medical practitioner.

Our Spine & Neurosurgeon in Singapore
Dr Colum Nolan
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)

Dr Colum Nolan is a Senior Consultant Neurosurgeon with over 20 years of experience, specialising in minimally invasive spine (keyhole) surgery and other spine procedures. 

A graduate of the Royal College of Surgeons in Ireland, Dr Nolan underwent neurosurgical training in Ireland and Australia, followed by a fellowship in complex spine surgery at Addenbrooke’s Hospital, Cambridge, as well as rotations at the Orthopaedic Spine Unit in Norfolk and Norwich Hospital. 

Dr Colum is committed to delivering compassionate, patient-centred care, combining surgical precision with a genuine dedication to improving his patients’ quality of life.

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