Nanoneurosurgery: Pioneering a paradigm shift for the 21^st century

Dear Editor,

For over a century, neurosurgery has evolved through successive technological revolutions. With the introduction of the operating microscope, neurosurgeons achieved levels of precision in tumor, vascular, and spinal procedures that were previously impossible; stereotaxy and endoscopy broadened minimally invasive approaches; navigation and intraoperative imaging reshaped operative safety.[2] Each technological advance gradually extended the limits of what neurosurgeons could accomplish in clinical practice. At present, the field is approaching another turning point – one defined by the integration of nanotechnology into clinical neurosurgery.[1,4,6]

I propose Nanoneurosurgery as a new frontier: the convergence of nanotechnology, biotechnology, and regenerative medicine with neurosurgical expertise. Unlike incremental advances, this is a paradigm shift, with the potential to change not only how we remove pathology but also how we regenerate, repair, and restore the nervous system.[4,6,7]

WHY NANONEUROSURGERY?

Conventional neurosurgery remains constrained by biological barriers and limited regenerative capacity. Glioblastoma multiforme still carries dismal outcomes despite maximal therapy.[4] Nerve gaps beyond critical lengths remain irreparable with current grafts.[3] Neurodegeneration and spinal degeneration continue to impose global socioeconomic burdens.[5,6]

Nanotechnology provides a new toolkit with capabilities not achievable by conventional methods, particularly in drug delivery, tissue repair, and regenerative approaches:

• Targeted nanoparticle therapeutics capable of crossing the blood–brain barrier[1,6,8]

• Nanostructured scaffolds and conduits guiding peripheral nerve and spinal cord regeneration[3]

• Nano-engineered implants and coatings improving durability, biocompatibility, and infection resistance[9]

• Molecular nanomedicine with genetic and cellular engineering for neuronal repair.[4,6-8]

These strategies are not theoretical speculations; experimental data already demonstrate feasibility in oncology, neurovascular care, and peripheral nerve repair. Preclinical data already demonstrate feasibility across oncology, neurovascular interventions, and nerve repair.[1,3,4,7]

A GLOBAL AND LOW- AND MIDDLE-INCOME COUNTRY (LMIC) PERSPECTIVE

As a neurosurgeon working in a LMIC, I witness firsthand the dual burden of limited resources and rising demand for advanced care. Nanoneurosurgery represents not only an opportunity for scientific advancement but also an equalizer: LMICs can join at the ground floor of this emerging field. By investing in translational nanolabs, training programs, and collaborative networks, LMIC neurosurgeons can contribute directly to global innovation rather than waiting decades for technology transfer.[4,6,7]

A CALL FOR COLLABORATION

A review of neurosurgical history reveals that transformative steps have always relied on collective collaboration and global exchange. Microsurgery, endoscopy, and functional neurosurgery were established through global collaboration, societies, and training programs.[2] To make nanoneurosurgery a reality, similar structures are urgently required:[3,4,6-8]

• Dedicated societies and working groups within WFNS and other bodies

• Specialized fellowships combining neurosurgery, nanotechnology, and biotechnology

• Multicenter translational trials evaluating nanostructured scaffolds, targeted nanoparticles, and neurodegenerative devices.

CONCLUSION

Progress in neurosurgery has consistently been driven by ambitious concepts that initially appeared unrealistic but later became standard practice. That at first seemed visionary, even impossible. Today, nanoneurosurgery offers us the chance to pioneer therapies that not only excise disease but also regenerate tissue, restore function, and redefine what is surgically achievable. Looking forward, it is likely that many of the defining innovations of 21^st-century neurosurgery will emerge under the framework of nanoneurosurgery. Its foundation is being laid now – and it is our collective responsibility to ensure that this vision becomes a recognized discipline, serving patients across all nations.

Ethical approval:

Institutional review board approval is not required.

Declaration of patient consent:

Patient’s consent is not required as there are no patients in this study.

Financial support and sponsorship:

Nil.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.