Comprehensive Summary
This review examines how the integration of AI-guided CRISPR editing, along with real-time multi-omics technologies, is reshaping precision neurosurgery in glioblastoma. The authors survey advances– intraoperative single-cell RNA sequencing, mass spectrometry, and genomic profiling– that allow surgeons to tailor interventions based on molecular insights. It is described how CRISPR-Cas9 strategies targeting oncogenic drivers like EGFRvIII could, in real time during surgery, disrupt tumor signaling, and how AI-driven radiogenomic models integrate imaging and molecular data to inform prognosis and guide surgical decisions. Detailed findings include the diagnostic power of intraoperative molecular techniques, the potential of CRISPR for immediate genetic modulation, and the use of multi-omics layers to clarify both tumor behavior and therapeutic resistance. However, on one hand, there are significant ethical, technical, and access challenges, such as blood-brain barrier delivery issues and genomic privacy concerns, involved with the nanotechnologies. Thus, the authors stress that while precision neuro-oncology stands at an inflection point, transitioning to a molecularly informed surgical paradigm will require robust ethical frameworks, equitable access, and interdisciplinary collaboration.
Outcomes and Implications
This work is crucial as it potentially transforms glioblastoma management from broadly anatomical resection toward tailored, molecularly informed interventions with the promise of better specificity and outcomes. By enabling real-time molecular diagnostics and editing via CRISPR, neurosurgeons could adapt surgical strategy on the fly, aiming not just to remove tumor mass but to correct or block oncogenic drivers intraoperatively. Clinically, these tools could accelerate diagnosis, improve resection accuracy, personalize adjuvant therapy selection, and perhaps pave the way to modifying disease course rather than solely managing symptoms. While preclinical studies show promise, the timeline for actual clinical implementation remains exploratory. The authors call for adaptive clinical trials and training programs to build the infrastructure and expertise needed to bring these innovations into neurosurgical practice.