The main quest with today's neurosurgical challenges is to deliver world-class therapy accurately and efficiently to a precise spot in the brain and spine. Interactive image-guided neurosurgery is the process whereby normal images such as x-rays, computed tomographic scans, and magnetic resonance imaging of the brain and spine can be coupled with directional devices to allow the surgeon to find a precise spot in the brain or spine, and utilize the most efficient route to that spot. At the Detroit Medical Center, Harper University Hospital and Detroit Receiving Hospital, a variety of techniques are available. Stereotactic frames including Leksell and Brown-Robert-Wells frames have been in use for years and have been the foundation to launch us into an era of frameless stereotactic surgery. In the latter evolution, the patient no longer needs to wear a metal device around the head during the execution of the surgery, but instead has fine points on the skull, scalp, or spine registered in the computer, which compares these points with the brain and spine radiology images, to produce a precise map of the intended surgical targets. In addition, at Harper University Hospital, an intraoperative magnetic resonance imaging device allows the surgeon to address that position throughout the case depending on both the extent of resection of the particular process such as a tumor or arteriovenous malformation, as well as the movement of the brain once the skull has been opened. Interactive image-guided neurosurgery allows the surgeon to be more precise and make smaller incisions, but continue to deliver maximally effective care at the site of the surgery. Interactive image-guided neurosurgery seeks to create real-time visualization of the intraoperative imaging data creating the possibility to see the relevant changes through the brain and spine as a result of the surgeon's intervention. For example, in spinal disease, the use of flexion-extension MRI intraoperatively allows the surgeon to see the effect of bony removal on the remaining ligamentous structures and to determine in a real-time fashion whether additional stabilization procedures are relevant.

The role of interactive image-guided neurosurgery is expanding at the Detroit Medical Center with the use of intraoperative angiographic localization in three dimensions, which allows for more precise and complete angiographic care.