A surgical guidance system is disclosed that allows for real-time imaging and patient monitoring during a surgical procedure. The system can include an MRI system for generating real-time images of the patient while surgery is being performed. Prior to surgery, a surgical plan can be created using a planning interface. A control unit receives the real-time image data and the surgical plan, and monitors the image data based on parameters included in the surgical plan. The control-unit monitoring occurs in real-time while the surgical procedure is being performed. The control unit can detect deviations from the surgical plan and/or high-risk patient conditions and instruct an alert unit to issue an alert based on the detected conditions.