Elasticity-guided tumor resection: applying biomechanical information to neurosurgical practice

Tumor stiffness and adhesion are decisive factors in neurosurgical strategy, yet they remain absent from standard planning and navigation. Advances in biomechanics allow these properties to be measured and mapped across modalities: magnetic resonance elastography for preoperative stiffness and adhesion, intraoperative ultrasound elastography for real-time updates, and rheometry as biological ground truth. Emerging frameworks could integrate these measurements with artificial intelligence and multimodal neuroimaging to produce probabilistic maps of tumor consistency and brain-tumor interface quality. We define this concept as elasticity-guided neurosurgery: the incorporation of biomechanical parameters into surgical decision-making to improve safety, efficiency, and personalization. By transforming tactile impressions into actionable data, elasticity-guided neurosurgery could represent a paradigm shift toward more information-driven neurosurgical oncology.