Brain–gut–microbiome signaling under neurosurgical stress: perioperative and translational perspectives

The gut microbiome and central nervous system (CNS) communicate through multiple pathways collectively termed the brain-gut axis. Surgical procedures, particularly those involving the CNS, represent a significant physiological stressor that may influence this communication network. This commentary examines published literature on perioperative changes in gut microbiome composition, explores the proposed mechanistic pathways underlying brain-gut interactions during surgical stress, and reviews preliminary clinical evidence for microbiome-targeted interventions for patients in the perioperative setting. The existing research, while still in early stages, points to the gut microbiome as an area that may warrant consideration in perioperative care strategies.