Introduction: This study evaluates the role of mri-guided neurosurgery in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a retrospective cohort analysis. Materials and Methods: A retrospective cohort study was conducted on 240 patients from January 2017 to June 2023 at a tertiary care center. Patients were divided into iMRI-guided (n=120) and Conventional navigation (n=120) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The iMRI-guided group demonstrated significantly improved primary outcomes compared to Conventional navigation (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.