Brain-computer interfaces and neuroprosthetics in the next era of neurosurgery

Brain-computer interfaces (BCIs) and neuroprosthetic systems are rapidly advancing from experimental concepts to clinically meaningful technologies capable of restoring communication, movement, sensation, and therapeutic neuromodulation. This review examines the current state of BCI and neuroprosthetic technologies, their neurosurgical applications, emerging frontiers, and the evolving role of neurosurgeons in their clinical translation.

A narrative review of the contemporary literature was performed, focusing on neural signal acquisition technologies, including intracortical microelectrode arrays, electrocorticography, depth electrodes, and endovascular recording systems. The review also evaluates advances in neural decoding algorithms, closed-loop stimulation paradigms, neuroprosthetic applications, long-term implant stability, cognitive and affective BCIs, and ethical and regulatory considerations relevant to neurosurgical practice.

Recent developments in neural interface design, implantable electronics, adaptive decoding algorithms, and closed-loop neuromodulation have enabled substantial progress in motor restoration, sensory feedback, speech decoding, and therapeutic neuromodulation. Intracortical and minimally invasive recording systems have expanded the range of achievable clinical applications, while adaptive deep brain stimulation and responsive neurostimulation demonstrate the growing importance of closed-loop approaches. Key challenges remain, including foreign body reactions, long-term signal instability, neural signal drift, and ethical concerns related to cognitive applications, privacy, and data security.

BCIs and neuroprosthetics are transforming the neurosurgical landscape by providing new opportunities to restore lost neurological function and deliver personalized neuromodulation therapies. Continued advances in biological integration, system adaptivity, and cognitive applications are expected to accelerate clinical adoption. As these technologies mature, neurosurgeons will play a central role in implantation, long-term management, and the responsible clinical translation of neural interface technologies.