Search Results (219)

The educational pathway for expertise in intraoperative neurophysiological monitoring (IONM) is complex and lengthy, requiring a solid foundation in neuroscience, neurophysiology, and neuroanatomy. It also demands direct familiarity with a broad range of neurosurgical scenarios, including supratentorial, infratentorial, and spinal procedures, gained through exposure to at least ten distinct surgical approaches. Intraoperative neurophysiology must be tailored to each patient’s preoperative assessments. It relies on a variety of methods to collect, analyze, and report neurophysiological signals that are relevant to the surgical procedure. Despite its importance, there remains a substantial shortage of training tools designed to support realistic practice and skill development. To address this gap, we developed a comprehensive framework (ION-Sim) that integrates all laboratory testing modalities and adapts them to the operating room environment. ION_sim supports the simulation and analysis of spontaneous EEG and EMG activity, a wide range of evoked potentials, and intraoperative stimulus–response testing protocols. The framework provides a unified environment for practicing, testing, and validating the core neurophysiological procedures employed during neurosurgical interventions. In addition, it incorporates a robust data-management architecture, maintaining a database with system setups, user profiles, educational performance metrics, and automatically generating reports. This structure enables the longitudinal tracking of objective skill acquisition and facilitates standardized assessments of trainee progress. ION_Sim is distributed both as a ready-to-use application, suitable for direct integration into teaching and training programs, and as a modular scientific library. Through its dedicated APIs, users can design customized configurations, create novel simulation scenarios, and extend the platform to support additional research or educational objectives. It is available upon request for educational purposes and is open-source and released under the GNU General Public License, ensuring transparency, reproducibility, and long-term accessibility for the scientific and clinical communities. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly being integrated into vascular surgery, particularly in diagnostic imaging, perioperative planning, intraoperative guidance, and postoperative surveillance. This literature review evaluates the current applications of artificial intelligence in vascular surgery and endovascular practice, with a particular focus on imaging technologies and their role in improving diagnostic precision, workflow efficiency, and patient outcomes. In addition, the review examines emerging AI applications in operative workflow optimization, endovascular navigation, postoperative surveillance, training platforms, and AI-assisted clinical decision support. Methods: A literature review was conducted using PubMed and Scopus with the search terms: (artificial intelligence OR AI OR neural network) AND (vascular surgery) AND (diagnosis OR treatment). Reference lists of included studies were manually screened, and additional recent studies were identified from relevant journals. Articles published in English up to April 2026 were included. Studies were assessed for their applications in vascular diagnostics, plaque characterization, endovascular workflow optimization, and postoperative surveillance. Results: AI demonstrated strong diagnostic performance across multiple imaging modalities. Deep learning systems achieved a sensitivity of 91.3% and specificity of 95.2% in peripheral arterial stenosis classification, while plaque characterization models showed accuracies up to 96% and substantial agreement with expert imaging interpretation. AI-assisted operative systems improved procedural efficiency through reductions in operative duration, radiation exposure, and contrast utilization. However, many studies were retrospective, single-center, and based on relatively small cohorts with heterogeneous endpoints. Conclusions: AI has significant potential to improve vascular surgical practice through enhanced image interpretation, procedural guidance, and individualized treatment planning. Despite promising outcomes, current evidence remains limited by methodological heterogeneity and insufficient external validation. Prospective multicenter studies and standardized evaluation frameworks are required before widespread clinical implementation can be achieved. Full article

Background: Accurate presurgical localization of eloquent cortex and subcortical pathways is essential in neurosurgery, guiding the balance between maximal safe resection and preservation of neurological function. This narrative review compares the clinical utility of task-based functional magnetic resonance imaging (tb-fMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) in neurosurgical populations, with emphasis on brain tumors and epilepsy. Methods: This narrative review was based on a non-systematic literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar from database inception to March 2026. The review focused on tb-fMRI and rs-fMRI for presurgical functional mapping in neurosurgical populations, including clinical utility, feasibility, validation, limitations, and workflow integration. Results: Tb-fMRI remains the most established noninvasive modality for motor and language mapping and language lateralization because of its task-specific activation maps and established role in clinical workflows. However, its use is limited by dependence on patient cooperation, task performance, and intact neurovascular coupling; thus, aphasia, cognitive impairment, fatigue, paresis, pediatric age, sedation, and tumor-related neurovascular uncoupling may render tb-fMRI inconclusive or misleading. Rs-fMRI offers a task-free alternative based on intrinsic functional connectivity, enabling simultaneous mapping of multiple resting-state networks from a single acquisition and providing particular value in non-cooperative, cognitively impaired, aphasic, pediatric, or sedated patients. Evidence indicates that rs-fMRI is most robust for sensorimotor mapping, with reported agreement with tb-fMRI and intraoperative direct electrical stimulation, whereas language mapping remains less consistent and more dependent on analytical methodology. Neither modality replaces intraoperative stimulation, which remains the reference standard. Conclusions: Current evidence supports a multimodal presurgical strategy in which tb-fMRI is used first-line in cooperative patients; rs-fMRI is added when task-based mapping is limited or infeasible, and both are interpreted alongside tractography, neuronavigation, and intraoperative mapping. Full article

Background: Precise intraoperative localisation of small colorectal tumours during laparoscopic surgery remains challenging due to absent tactile feedback and subserosal tumour location. Current standard methods, particularly India ink tattooing, demonstrate 15–30% failure rates for lesions less than 10 mm, leading to prolonged operative times, incomplete resections, and re-operations. Multiple emerging technologies promise improved localisation, yet comparative evidence remains fragmented. Objective: To map and characterise the current landscape of intraoperative marking and identification technologies for small colorectal tumour localisation during laparoscopic surgery, with emphasis on radiofrequency-based methods and alternative approaches, and to identify evidence gaps guiding future research. Methods: Following PRISMA-ScR guidelines, we systematically searched PubMed, Web of Science, and Scopus databases from January 2000 through December 2025 for studies evaluating tumour localisation technologies in colorectal cancer surgery, including primary tumour localisation during laparoscopic colectomy and localisation of colorectal liver metastases during hepatic surgery, or transferable anatomical applications with documented translational potential to colorectal surgery. Two independent reviewers screened all records, with discrepancies resolved through discussion and a third senior reviewer consulted for unresolved disagreements; data were extracted on technical performance, safety, feasibility, cost-effectiveness, usability, innovation potential, and evidence quality. Results: We included 89 studies comprising 18 colorectal-specific articles and 71 transferable/GI-adjacent studies. Detection success rates ranged from 71% to 100% across modalities. Near-infrared fluorescence with indocyanine green demonstrated the strongest clinical evidence with 75–100% detection across eight colorectal studies encompassing 2134 procedures and seamless workflow integration. Radiofrequency identification systems achieved 91.9–99% detection in feasibility studies with promising tissue penetration of 15–35 mm but limited colorectal validation. Electromagnetic navigation excelled in rigid organs with 85–98% success but showed degraded performance in mobile bowel at 71–75%. Critical evidence gaps included absent head-to-head comparative trials, non-standardised outcome metrics limiting cross-study comparability, and limited long-term safety data with only 14 studies providing follow-up exceeding six months. Conclusions: ICG fluorescence represents the most clinically mature technology identified, representing a priority candidate for colorectal-specific validation in challenging localisation scenarios. RFID systems demonstrate promising characteristics justifying prioritised research investment through adequately powered comparative trials. Future research must emphasise consortium-based comparative effectiveness studies, standardised outcome metrics, and integration with robotic and AI-assisted surgical platforms to accelerate clinical translation. Full article

As thoracic surgeons more frequently address smaller lung lesions and perform lung-sparing resections, their objective is to resect an adequate specimen and margin without removing excess healthy lung tissue. Although perioperative lung nodule localization has been in practice for decades, the existing and emerging techniques used for the identification of targeted and occult lesions are more widely utilized today than they were in the past. In this review, we detail the logic behind this increase in use, classify the techniques into preoperative and intraoperative categories, and define the specific modalities available. Where applicable, we review the published data comparing techniques, detailing efficacy and safety. In the preoperative space, we describe standard computed tomography (CT)-guided localization, virtual-assisted lung mapping, electromagnetic navigation bronchoscopy, robotic-assisted bronchoscopy, and novel fiducial markers. In the intraoperative space, we describe classical localization techniques, novel applications of intraoperative cone-beam CT, and fluorescence-guided surgery and intraoperative molecular imaging (IMI). Lastly, we review emerging approaches for intraoperative molecular imaging including a report on agents in early-stage clinical trials and a brief survey of promising preclinical models. With each approach mentioned, we analyze the potential benefits and hazards, and appraise the evidence for (or against) the use of any specific modality. Full article

Endoscopic resection (ER) has become the preferred curative-intent treatment for early upper gastrointestinal cancer, given its superior safety profile compared to surgery. Over the past decade, technological and procedural innovation has substantially expanded the scope, safety, and precision of endoscopic submucosal dissection (ESD) and related techniques. This review synthesises current evidence on key advances relevant to upper gastrointestinal ESD practice. Enhanced imaging modalities have improved lesion detection and characterisation, as well as recognition of intraoperative anatomical structures during third-space endoscopy. A new generation of therapeutic endoscopes combines high-definition optics with substantially improved tip-down angulation and channel size, addressing a longstanding gap between diagnostic-class image quality and procedural capability. Resection strategies—including mechanical traction systems, saline immersion therapeutic endoscopy (SITE), and luminal drainage techniques—have reduced procedural complexity and improved dissection conditions. Dedicated closure technologies have improved management of large resection defects, potentially reducing resection-related morbidity. Deep resection techniques, including submucosal tunnelling endoscopic resection (STER), device-assisted endoscopic full-thickness resection (FTRD), knife-assisted full-thickness resection (kFTR), and endoscopic intermuscular dissection (EID), are extending organ-preserving resection to deeply invasive cancers and subepithelial lesions. Management of non-curative ESD resections is being refined through multicentre risk stratification studies. Advances in simulation, competency-based training, and artificial intelligence hold promise for standardising technique acquisition and real-time procedural support. Together, these innovations are reshaping upper gastrointestinal oncology by positioning minimally invasive, organ-preserving digestive endoscopy as a central therapeutic strategy. Full article

Spinal cord stimulation (SCS) is an established therapy for chronic pain, yet treatment response remains highly variable and patient selection largely empirical. The identification of biomarkers with the potential to predict and monitor therapeutic response is therefore critical for advancing toward precision neuromodulation. This study provides a structured narrative synthesis of current evidence on biomarkers in SCS, focusing on their predictive and monitoring roles and their translational potential. Available studies were analysed across electrophysiological, neuroimaging, autonomic, and molecular domains and conceptually organized into predictive biomarkers—reflecting baseline biological states associated with treatment susceptibility—and monitoring biomarkers, capturing physiological and molecular adaptations following stimulation. Among predictive approaches, intraoperative electroencephalography (EEG) and resting-state functional magnetic resonance imaging (rs-fMRI) have shown promising but exploratory discriminative performance. However, EEG findings are derived from intraoperative settings, limiting their applicability to pre-implantation patient selection. In contrast, monitoring biomarkers—including heart rate variability, metabolic imaging, and immunological parameters—provide objective measures of treatment-induced changes but do not currently support predictive use. Molecular and genomic biomarkers, while mechanistically informative, remain exploratory and lack validated clinical utility. A central limitation of the field is the fragmentation of biomarker research, with most studies evaluating single modalities in isolation. To address this gap, we propose a translational framework integrating predictive and monitoring biomarkers through a two-stage model combining baseline stratification with longitudinal response assessment. Although biomarker research in SCS is rapidly evolving, its clinical application remains limited. The development of multimodal, validated biomarker strategies may support improved patient selection and more objective evaluation of treatment response, enabling a transition toward mechanism-based neuromodulation. Full article

Background: Brain metastases are the most common intracranial tumors in adults and are traditionally considered well-demarcated lesions amenable to complete surgical resection. Nonetheless, increasing histopathological evidence demonstrates that metastatic cells may infiltrate beyond the contrast-enhancing margin into surrounding brain parenchyma, challenging the reliability of conventional imaging for defining true tumor boundaries. Confocal laser endomicroscopy (CLE) using Sodium Fluorescein (SF) has emerged as a novel intraoperative imaging modality capable of providing real-time, high-resolution optical biopsies, potentially improving margin assessment during metastasis surgery. Methods: A systematic literature search was performed according to PRISMA guidelines across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar up to 3 March 2026. Studies evaluating intraoperative CLE with SF in adult patients with brain metastases were included. Data regarding study design, patient population, CLE system, imaging characteristics, and diagnostic performance were extracted. Risk of bias was assessed using the QUADAS-2 tool. Results: Ten studies met the inclusion criteria for qualitative synthesis, comprising over 650 patients; however, most studies included heterogeneous intracranial tumor populations, with only a subset specifically involving brain metastases. CLE enabled real-time visualization of tumor microarchitecture and demonstrated high sensitivity for tumor detection, frequently exceeding 90% in prospective studies. Specificity varied across studies, reflecting challenges in distinguishing tumor infiltration from reactive tissue at the tumor–brain interface. The MetInfilt trial highlighted that infiltrative growth patterns are common in brain metastases and can be visualized intraoperatively using CLE. Additional studies demonstrated that fluorescein-based CLE allows differentiation of tumor zones and may facilitate targeted margin assessment; however, evidence demonstrating improvement in clinically meaningful outcomes such as extent of resection, local recurrence, progression-free survival, or overall survival remains limited. Conclusions: Confocal laser endomicroscopy using SF represents a promising intraoperative adjunct for assessing tumor margins in brain metastasis surgery. By enabling real-time microscopic visualization of the metastasis–brain interface, CLE may support a more biologically informed surgical strategy. Full article

Background/Objectives: We report a case of severe dermatomyositis demonstrating characteristic widespread extraosseous uptake on ^99mTc-methylene diphosphonate (^99mTc-MDP) bone scintigraphy. This study highlights the diagnostic value of this modality in detecting active inflammatory myopathy when conventional muscle biopsy is inconclusive and introduces its novel use for intraoperative gamma-probe-guided biopsy to precisely target metabolically active muscle. This approach may help target metabolically active muscle in heterogeneous idiopathic inflammatory myopathies (IIMs). Case Presentation: A 49-year-old man developed progressive proximal muscle weakness (Medical Research Council grade 2/5 proximally, 5/5 distally) beginning in June 2025 following influenza infection, accompanied by dysphagia, classic dermatomyositis cutaneous manifestations, back pain, and difficulty standing. Laboratory evaluation revealed elevated inflammatory markers (ESR 55 mm/hr, CRP 20 mg/L), leukocytosis (16.58 × 10⁹/L), markedly raised creatine kinase (19,937 IU/L), and troponin T levels. An initial quadriceps muscle biopsy performed on 29 July 2025 was non-diagnostic. Three-phase ^99mTc-MDP scintigraphy (~1110 MBq) demonstrated intense, diffuse extraosseous uptake involving bilateral deltoids (symmetric), biceps and triceps (patchy), paraspinal muscles (longitudinal), gluteal muscles, thighs (quadriceps and hamstrings), and gastrocnemius muscles, with relative suppression of appendicular skeletal uptake on delayed images due to soft-tissue tracer dominance—findings consistent with severe inflammatory myopathy. Following reinjection (~1100 MBq), intraoperative gamma-probe-guided biopsy targeted areas of highest uptake (left quadriceps femoris and distal triceps brachii; intraoperative counts 1300–1400 versus background ~500). Histopathology revealed histiocyte-predominant inflammation with myofibre necrosis and regeneration, sparse CD4⁺ T-cell infiltrates, and absence of fibrosis, consistent with necrotising myopathy. Positive antinuclear antibodies and strong anti-Mi-2 antibodies confirmed the diagnosis of dermatomyositis. Treatment included pulse methylprednisolone followed by oral prednisone taper, methotrexate, azathioprine, intravenous immunoglobulin, and planned rituximab therapy. Discussion: Whole-body ^99mTc-MDP scintigraphy provided a complementary whole-body functional assessment of disease extent, revealing widespread muscular involvement. The novel application of intraoperative gamma-probe-guided biopsy enabled real-time targeting of metabolically active muscle, facilitating targeted sampling after an initial non-diagnostic biopsy and yielding supportive histopathological findings. This dual diagnostic and interventional role demonstrates the technical feasibility of gamma-probe guidance in a diagnostically challenging case of dermatomyositis. Conclusions: In our case, the integration of ^99mTc-MDP scintigraphy with gamma-probe-guided biopsy enabled precise targeting of metabolically active muscle following an initial non-diagnostic biopsy. This multimodal approach may be useful in selected diagnostically challenging cases of severe inflammatory myopathy. Larger studies are needed to evaluate its reproducibility and added value. Full article

Background/Objectives: Intraoperative perfusion imaging can support determining the anastomosis site to avoid leakages after colorectal surgery. Indocyanine green–fluorescence angiography (ICG-FA) and hyperspectral imaging (HSI) have been used recently but suffering from different drawbacks. A comparison of quantitative perfusion parameters from both modalities should substantiate the relevance of HSI next to ICG-FA. A computational framework combining ICG-FA and HSI should be developed to overcome system-specific disadvantages. Methods: ICG-FA and HSI were performed in 26 non-consecutive patients undergoing any colorectal surgery at the University Hospital of Leipzig between November 2022 and December 2023 to compare the position of the transition between well- and poorly perfused areas in both imaging modalities, as well as to compare quantitative perfusion parameters. Hyperspectral data was acquired before, during, and after ICG-FA to reconstruct an ICG-mimicking image from HSI data for future combined applications. This approach was further tested by investigating the influence of ICG on HSI-derived tissue parameters. Results: Anastomotic leakage occurred in one case. Compared to the clinical assessment, the median position of the transection margin was 0.1 cm more proximal, 0.15 cm more proximal, and 0.36 cm more distal for ICG, reconstructed ICG, and HSI, respectively. The reconstructed ICG image resembled the ground truth in 21 cases. ICG did not show any relevant influence on HSI parameters. Conclusions: The results indicated subtle differences between ICG-based blood flow and HSI-derived tissue oxygenation visualisation, which can be combined for comprehensive intraoperative perfusion analyses using one HSI system only and an ICG-related signal reconstruction framework. Further studies need to address dose and the time dependencies of the combined usage of HSI and ICG. Full article

Background: Cage subsidence (CS) is among the main complications after oblique lumbar interbody fusion (OLIF) and may lead to the failure of indirect decompression. Accurate preoperative bone quality assessment is critical for risk stratification, yet the optimal imaging modality and diagnostic threshold remain unclear. Objectives: This study aimed to determine a quantitative computed tomography (QCT)-derived volumetric bone mineral density (vBMD) threshold for predicting CS after OLIF with posterior fixation. Methods: Patients undergoing OLIF with posterior fixation between July 2017 and March 2020 were retrospectively enrolled. Preoperative vBMD was measured using QCT as the average L2–L4 trabecular volumetric BMD. CS was defined as a loss of more than 2 mm of disk height on sagittal midline CT views between 3 days postoperatively and the last follow-up. Clinical and radiographic parameters including gender, age, body mass index, vBMD, number of operative levels, cage dimensions, disk height, segmental lordosis, intraoperative endplate injury, and fusion status were analyzed. Results: 86 patients (107 operative levels) with a mean follow-up of 20.6 months were included; 25 levels (23.4%) developed CS. Multivariate logistic regression identified vBMD (p < 0.001; OR 0.947; 95% CI 0.923–0.972) and intraoperative endplate injury (p = 0.031; OR 3.640; 95% CI 1.125–11.776) as independent risk factors. The area under the receiver operating characteristic curve (AUC) for vBMD was 0.847 (95% CI, 0.762–0.932), with an optimal threshold of 83.0 mg/cm³ (sensitivity 84.0%, specificity 76.8%). This threshold closely aligns with the American College of Radiology QCT criterion for osteoporosis (80 mg/cm³); however, given that it was derived from a single-center retrospective cohort, external validation in multi-center studies is warranted before broad clinical adoption. Fusion rates differed significantly between CS and non-CS groups (84.0% vs. 96.3%, p = 0.029). Conclusions: QCT-derived vBMD provides a phantom-calibrated, protocol-standardized metric for preoperative risk stratification of cage subsidence after OLIF. Full article

Hyperspectral (HS) imaging has proven to be a promising intraoperative tool for tissue discrimination. However, obtaining representative datasets for intraoperative imaging remains challenging due to the complexity of surgical workflows and the sensitivity of the operating environments. Hence, developing new methods for cross-system feature adaptation could address this limitation. This work proposes a method for mapping high-resolution spectral data into lower-resolution sensor-conditioned domains, generating synthetic HS data that replicate the spectral features of the target system. We assessed the mapped data using public HS datasets and quantified spectral similarities using different metrics. Additionally, we evaluated the method with a HS classification framework for an intraoperative brain tumour classification problem. Results demonstrate that the synthetic data achieve high spectral alignment to original and actual data, captured with the target system. The brain tumour classification results show comparable performance between data modalities. Overall, this work provides a way to adapt existing HS datasets to complement newly acquired data, accelerating the development of artificial intelligence algorithms. This is particularly relevant in medical research, and especially in neurosurgery, where the complexity of acquisition environments limits the collection of large datasets. Full article

Background: The rising incidence of vertebral body fractures, vertebral infections and metastatic disease increases the need for diagnostic modalities with high specificity. Biopsy remains essential, yet comparative data on CT-guided versus intraoperative percutaneous fluoroscopy-guided biopsy are limited. Methods: This retrospective study compared two cohorts biopsied for spinal lesions between April 2015 and April 2024: CT-guided biopsy (n = 62), and intraoperative percutaneous biopsy (n = 154). Groups were analyzed for demographic and clinical characteristics, and diagnostic yield was defined by the conclusiveness of the primary biopsy; statistical comparisons were performed using Fisher’s exact test. Results: CT-guided biopsy yielded conclusive results in 46 of 62 cases (74.2%), whereas intraoperative, fluoroscopy-guided biopsy was conclusive in 41 of 154 cases (26.6%), representing a statistically significant difference (p < 0.001). In analogy, propensity score matching (1:1) resulted in similar significant (p < 0.001) results (CT-guided group vs. intraoperative, fluoroscopy-guided group: 86.7% vs. 35.6%) Conclusions: CT-guided biopsy demonstrated a substantially higher rate of conclusive results compared with intraoperative biopsy in this cohort. Further studies with larger and more balanced cohorts are needed to strengthen clinical recommendations. Full article

Background: Endobronchial hamartoma (EBH) is an exceptionally rare benign neoplasm frequently misdiagnosed as an obstructive malignancy. The therapeutic paradigm is shifting from traditional anatomical resection toward parenchyma-preserving interventional techniques. This study evaluates the efficacy and safety profiles of contemporary bronchoscopic interventions versus surgical management for EBH. Methods: A retrospective analysis was conducted on a clinical cohort of 17 patients treated between 2013 and 2026, alongside a comprehensive systematic review of 31 contemporary studies (2013–2025). The primary endpoint was the treatment success rate at 3 months, while secondary outcomes included perioperative complications, re-intervention rates, and successful lung parenchyma preservation. Results: Within the analyzed cohort (median age, 58 years), lesions exhibited a significant right-sided predilection (70.6%). Preoperative imaging uniformly revealed non-specific masses, with 41.2% displaying secondary obstructive manifestations. Definitive interventions comprised bronchoscopic management (n = 11, 64.7%) and surgical resection (n = 6, 35.3%). The technical success rate was 100%, with zero major perioperative complications and only minimal-to-scant intraoperative bleeding reported. Over a median follow-up of 3 months, local recurrence was observed in three cases (17.6%)—notably spanning both surgical (n = 2) and bronchoscopic (n = 1) modalities. The systematic review corroborated these findings, underscoring the exemplary safety profile and superior lung-sparing capacity of bronchoscopic interventions. Conclusions: Within the limits of this retrospective cohort and literature review, interventional bronchoscopy appears to be a safe and lung-sparing approach. It may be considered as a preferable initial treatment option for anatomically suitable EBHs. Traditional surgical resection remains necessary for anatomically complex lesions or cases with irreversible distal parenchymal destruction. Vigilant longitudinal surveillance is advised across all modalities. Full article

Background: Eyelid malignancies require accurate intraoperative margin control to achieve complete tumor excision while preserving the functional and aesthetic integrity of the periocular region. Mohs micrographic surgery (MMS) is widely regarded as the reference standard for margin-controlled excision, whereas frozen section–controlled excision (FSC) represents a reliable and widely used alternative in oculoplastic practice. In parallel, several emerging imaging technologies are being investigated to improve real-time tumor detection and surgical precision. Methods: A narrative review of the literature was conducted to summarize current evidence on intraoperative margin control in eyelid tumor surgery. The review focused on established surgical techniques, including MMS and FSC, as well as emerging imaging modalities such as fluorescence confocal microscopy, reflectance confocal microscopy, optical coherence tomography, line-field confocal optical coherence tomography, photoacoustic imaging, and artificial intelligence (AI)-assisted analysis. Results: MMS provides complete circumferential peripheral and deep margin assessment and remains the benchmark for high-risk, recurrent, and poorly defined periocular tumors, particularly basal cell carcinoma. FSC offers favorable oncologic outcomes, allows immediate reconstruction, and remains an effective option when MMS is not available. Emerging imaging modalities have shown promising diagnostic performance for tumor detection, presurgical mapping, and intraoperative support, particularly in basal cell carcinoma, although evidence in periocular tumors remains limited for most techniques. AI-assisted approaches have also demonstrated high accuracy in the interpretation of frozen sections and optical imaging data, suggesting potential to improve workflow efficiency and diagnostic consistency. Conclusions: MMS and FSC remain the current standards for intraoperative margin control in eyelid tumor surgery. Emerging imaging technologies and AI-based tools may further enhance surgical precision and tissue preservation, but most remain investigational in the periocular setting. Further prospective studies are needed to validate their clinical utility, define standardized workflows, and clarify their role alongside established histopathologic techniques. Full article