A Conceptual Framework for the Intelligent Intraoperative Surgical Guidance System (IISGS) in Precision Neurosurgery

Precision neurosurgery faces challenges from intraoperative brain shift (5–20 mm in 80% of cases) and complex anatomy, risking neurological deficits and hemorrhage. The Intelligent Intraoperative Surgical Guidance System (IISGS) is a novel AI-driven framework integrating computer vision, reinforcement learning (RL), and sensorless haptic feedback to enhance surgical precision. IISGS compensates for brain shift up to 10 mm (95% CI: [8.5, 11.5] mm) and integrates with robotic platforms like da Vinci Xi, achieving a simulated 25–30% reduction in complications (95% CI: [22%, 33%], p<0.01). The framework leverages multimodal data (MRI/CT/fMRI, ultrasound/video), U-Net segmentation (Dice 0.95 ± 0.02), symmetric diffeomorphic registration, and Deep Q-Network (DQN) path optimization. Validated on 5000 BRATS 2020 images, IISGS includes a clinical data flow diagram and a 2026–2028 roadmap adhering to CONSORT/PRISMA standards. As a self-contained conceptual study, it offers a scalable solution for global neurosurgical applications, including glioma resection, epilepsy surgery, and aneurysm clipping.