Functional Approach To Neurosurgery: Current Research and Future Perspectives

In the last few years, the approach to neurosurgery has dramatically changed, and now respect for neurological function has become mandatory in every neurosurgical procedure. Thus, the "function" is today crucial in approaching neurosurgery in what we can define the "functional approach" to neurosurgery. Classically, the field of neurosurgery devoted to the function has been functional neurosurgery, in which neurosurgeons modify the functioning of the nervous system, by electrical brain or spinal cord modulation in movement disorders or chronic pain, by removing an epileptogenic zone in the brain in epilepsy syndromes or by removing an arterial compression in case of neurovascular conflicts. However, the concept of the functional approach has extended to other areas, such as neuro-oncology, vascular and spine surgery. For example in neuro-oncology, the post-operative functional status of the patient is now crucial because it has clearly been associated with a more prolonged overall survival in malignant gliomas. Thus, an oncological-functional balance is now at the base of the modern neuro-oncology.

The preoperative study of functional brain regions and their relationships with the tumor by functional magnetic resonance imaging together with the widespread of intraoperative neuro-monitoring and brain mapping techniques, permit a safer removal of a brain tumour also in the so-called eloquent areas. Furthermore, the routine application of neuro-monitoring in vascular and spine surgery is improving the functional outcome of patients. The artificial intelligence and the learning machine approach together with the connectomics may further increase our understanding of neural networks to improve neurosurgical patients' outcomes.

The scope of this Research Topic is to collect outstanding papers exploring the potentiality of functional approaches in all fields of neurosurgery.