In the high-stakes environment of neurosurgery, real-time insights into cerebral blood flow are critical for surgical accuracy and patient outcomes. Traditionally, indocyanine green (ICG) fluorescence imaging has been the go-to method—but the rise of infrared imaging is now offering a non-invasive, contrast-free alternative that could significantly improve intraoperative decision-making.

How infrared thermal imaging works in neurosurgery

Infrared thermography detects subtle temperature variations across the brain’s surface, caused by blood flow. These variations are used to create high-resolution thermal maps, allowing surgeons to visualise cerebral circulation patterns that would otherwise be invisible.

Because this method is non-contact and does not interrupt the procedure, it offers seamless integration into neurosurgical workflows—particularly in operations such as cerebrovascular bypass. Compared to ICG imaging, infrared thermal imaging offers key advantages:

  • Continuous real-time monitoring without contrast agents

  • Reduced procedural risk and disruption

  • Enhanced visualisation of perfusion and vascular structures

  • High-resolution imaging to support clinical accuracy

Clinical validation: moyamoya disease surgery

Clinical use of infrared imaging is expanding. In China, surgical teams have used thermal imaging during STA-MCA bypass procedures for moyamoya disease—an advanced cerebrovascular condition. This approach allowed for clearer visualisation of blood flow and real-time feedback, supporting intraoperative decisions and enhancing surgical outcomes.

For more on the technology’s clinical applications, Radiopaedia offers a helpful overview of current uses in medical imaging.

Looking ahead: the future of surgical imaging

Infrared thermal imaging is gaining ground not only in neurosurgery but also in broader surgical and emergency contexts. As manufacturers develop clinical-grade thermal systems and integration becomes more widespread, this imaging method could become a standard tool in minimally invasive, precision-guided procedures.

Adoption will require regulatory and clinical guidelines to keep pace—ensuring consistency, safety, and efficacy across healthcare systems. However, the benefits are clear: infrared thermal imaging has the potential to redefine how surgeons assess vascular dynamics in real time, improving both safety and outcomes.

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