Future of Robotics in Neurosurgery

authors: [bhushan thombre]
date: 2025-08-25
tags: [Neurosurgery, Robotics, AI, Spine Surgery, DBS]
doi: https://doi.org/10.5281/zenodo.16945094 

Robotic systems are increasingly becoming integral to neurosurgery, providing enhanced precision, accuracy, and safety. While robotics in other surgical specialties (e.g., urology, orthopedics) is well established, neurosurgery presents unique challenges due to the microscopic scale and critical functional anatomy of the nervous system.

Current Applications

• Stereotactic Neurosurgery
  Robotic platforms facilitate accurate placement of deep brain stimulation (DBS) electrodes, stereoelectroencephalography (SEEG) leads, and biopsies, with accuracy often exceeding manual frame-based methods【1】.

• Spinal Instrumentation
  Robots aid in pedicle screw placement with reduced fluoroscopy time and improved accuracy compared to free-hand or navigation-assisted techniques【2】.

• Microsurgical Assistance
  Experimental robotic arms with tremor filtration and enhanced dexterity show promise for microvascular anastomosis and tumor resection【3】.

Advantages

• Sub-millimetric accuracy
• Integration with multimodal imaging and navigation systems
• Reduced radiation exposure during spine surgery
• Potential for minimally invasive approaches

Limitations

• Cost and Maintenance – Robotic platforms remain expensive and may not be feasible for all centers.
• Learning Curve – Training requirements for neurosurgeons and OR teams are significant.
• Workflow Integration – Operative time may initially increase until proficiency is gained.
• Regulatory/Ethical Challenges – Particularly concerning autonomy and AI-assisted decision-making.

Future Directions

1. AI-Augmented Robotics – Integration of intraoperative data with AI for adaptive decision support【4】.
2. Enhanced Haptic Feedback – Overcoming the current limitation of tactile “disconnect.”
3. Remote Neurosurgery (Telesurgery) – Enabled by high-speed, low-latency communication (5G/6G).
4. Patient-Specific Models (Digital Twins) – Preoperative simulation guiding robotic trajectories.
5. Miniaturized & Flexible Robots – Catheter- or snake-like devices for deep brain access【5】.

Conclusion

Robotics in neurosurgery is moving from navigation-assistive tools toward intelligent, adaptive surgical partners. With ongoing advances in AI, imaging, and haptics, the next decade may see a transformation toward safer, more precise, and possibly semi-autonomous neurosurgical procedures.

References

1. Lefranc M, Capel C, Buffenoir K, et al. “Accuracy of robot-assisted stereotactic procedures in neurosurgery: a systematic review.” Neurosurgical Review. 2014.
2. Staartjes VE, Klukowska AM, Schröder ML. “Pedicle screw accuracy in robot-guided versus freehand fluoroscopy-assisted spinal surgery.” Spine. 2018.
3. Guthart GS, Salisbury JK. “The Intuitive Telesurgery System: Overview and application in neurosurgery.” Neurosurgical Focus. 2000.
4. Yang GZ, Cambias J, Cleary K, et al. “Medical robotics—Regulatory, ethical, and legal considerations for increasing levels of autonomy.” Science Robotics. 2017.
5. Burgner-Kahrs J, Rucker DC, Choset H. “Continuum robots for medical applications: A survey.” IEEE Transactions on Robotics. 2015.

Keywords: Robotics, Neurosurgery, Artificial Intelligence, Spine, Deep Brain Stimulation, Telesurgery