脳神経外科における術中画像と手術映像の活用—課題と未来への展望

Use of Intraoperative Images and Surgical Videos in Neurosurgery:Challenges and Future Prospects

Point

・手術シミュレーション，ナビゲーションシステム，外視鏡，術中MRIなどの術中画像技術は，術前計画の精密化，リアルタイムな手術支援，術後評価を通じて，脳神経外科手術の安全性と精度を飛躍的に向上させている．

・今後，AI（artificial intelligence）やロボット支援技術を含む各種技術が統合され，安全性・精度・効率性が飛躍的に向上し，患者転帰の改善や医療現場の最適化が期待されている．

・診療報酬や保険収載の適切な評価，エビデンス構築，制度改定が技術普及と高品質な医療提供の鍵となる．

　In recent years, advancements in intraoperative imaging technology, surgical visualization systems, Artificial Intelligence (AI）, and robotic-assisted technologies have significantly improved the precision, safety, and postoperative outcomes of neurosurgical procedures. Surgical simulation contributes to optimizing preoperative planning and enhancing the skills of young surgeons, while navigation technologies, utilizing optical or magnetic systems, enhance the accuracy of tumor resection. Intraoperative MRI and CT provide real-time assessment of residual tumors and vascular structures, and the integration of AI allows high-resolution imaging even with low-field MRI systems. Neuroendoscopes and exoscopes equipped with 4K resolution or 3D technology have improved visual precision, while AI aids in tumor boundary identification and postoperative outcome prediction. The integration of robotic technology further enhances surgical accuracy. However, challenges remain, including high implementation costs, inadequate reimbursement systems, insufficient evidence, and a lack of standardized operational guidelines. Integrating and standardizing these technologies will enhance surgical safety, precision, and efficiency, improve patient outcomes, and optimize healthcare workflows, necessitating policy reforms and robust evidence-based frameworks.