Probiotics in Neurosurgery and Neurodegenerative Diseases: Harnessing the Gut-brain Axis for Recovery

The gut-brain axis (GBA), a bidirectional communication network between gut microbiota and the central nervous system, is pivotal in regulating brain health through neural, immune, and endocrine pathways. Probiotics, live beneficial bacteria, modulate the GBA to enhance neurological recovery in neurosurgery and neurodegenerative disorders, offering a novel therapeutic approach. By producing short-chain fatty acids (SCFAs) and neurotransmitters (e.g., serotonin, BDNF), probiotics reduce neuroinflammation, strengthen blood-brain barrier integrity, and support neuroplasticity. In neurosurgery, strains like Lactobacillus reuteri and Bifidobacterium longum lower infection rates, improve gastrointestinal motility, and enhance cognitive outcomes in traumatic brain injury (TBI) and spinal surgery by mitigating systemic inflammation. In neurodegenerative diseases, such as Parkinson’s and Alzheimer’s, probiotics alleviate motor and cognitive symptoms by suppressing microglial activation and enhancing SCFA production. Synbiotics and emerging interventions, like probiotic-based wound dressings, further optimize outcomes by boosting immune responses and wound healing. However, strain-specific variability, small-scale trials, and inconsistent methodologies limit clinical translation. Future research should prioritize large-scale randomized controlled trials, personalized microbiome profiling, and novel strategies like postbiotics and psychobiotics to refine efficacy and dosing. By addressing these challenges, probiotics could become integral to neurosurgical and neurological care, improving recovery and quality of life through targeted GBA modulation.