Robotic-Assisted Minimally Invasive Cranial Neurosurgery: Surgical Applications and Anatomy-A Systematic Review

Area of Science:

• Neurosurgery
• Robotics Engineering
• Minimally Invasive Surgery

Background:

• Robotic systems in cranial neurosurgery are currently limited, primarily to stereotactic procedures.
• Advancements in robotics and minimally invasive techniques are driving renewed interest in transcranial and skull base applications.
• This review systematically examines the current state, challenges, and future potential of robotic assistance in cranial neurosurgery.

Purpose of the Study:

• To conduct a systematic review of robotic-assisted cranial neurosurgery beyond stereotactic applications.
• To analyze current robotic platforms, surgical approaches, and outcomes in cranial neurosurgery.
• To identify technical limitations and the translational potential of robotic systems in this field.

Main Methods:

• A systematic review adhering to PRISMA 2020 guidelines was performed across three databases.
• Studies included robot-assisted cranial procedures (transcranial, transnasal, transoral), excluding spinal and peripheral nerve interventions.
• Data extraction focused on study type, robotic platform, surgical approach, and patient outcomes.

Main Results:

• Twenty-seven studies (19 preclinical, 6 clinical, 2 translational) published between 2002-2025 were included.
• Preclinical studies utilized phantoms or donor heads for simulating robotic access.
• Clinical applications included skull base resections and orbital tumor surgery, with early data supporting feasibility for keyhole and skull base procedures.

Conclusions:

• Robotics offers significant potential for advancing minimally invasive cranial neurosurgery.
• Current robotic systems require refinement for optimal keyhole access and intracranial manipulation.
• Future development should prioritize miniaturized, neuronavigation-compatible robotic platforms for high-precision neurosurgical tasks.