Laser-assisted cranial bone drilling in neurosurgery: Translational potential, current evidence, and future...

Cranial bone drilling is a fundamental step in neurosurgical procedures, including burr-hole placement, craniotomy, and stereotactic interventions. Conventional high-speed drills, while effective, generate vibration, acoustic noise, and thermal injury, potentially compromising surgical precision and safety. Laser-assisted osteotomy has emerged as a contact-free alternative with the potential to improve accuracy and reduce mechanical trauma.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Scopus, and Google Scholar were searched for studies published between 1995 and 2024. Studies evaluating laser-based bone ablation relevant to cranial or neurosurgical applications were included. Outcomes assessed included cutting precision, thermal effects, bone healing, and clinical feasibility.

Of 312 identified studies, 42 met the inclusion criteria. Erbium-doped Yttrium Aluminum Garnet and femtosecond lasers demonstrated superior precision, reduced microfractures, and preservation of bone microarchitecture compared with conventional drilling. Thermal injury was minimal when pulsed systems and irrigation were used. However, the majority of evidence remains experimental, with limited neurosurgical clinical validation.

Laser-assisted cranial bone drilling represents a promising advancement in neurosurgery. Its greatest potential lies in integration with robotic and image-guided systems. Further clinical studies are required before routine adoption.