Robot-Assisted Stereotaxy in Functional Neurosurgery: An Updated Narrative Review

Abstract

Introduction/Background: Robot-assisted stereotaxy is increasingly used in functional neurosurgery because many procedures rely on predefined linear trajectories and rigid skull registration. It is particularly relevant for stereoelectroencephalography (sEEG), deep brain stimulation (DBS), and laser interstitial thermal therapy (LITT). Pediatric use requires special attention to skull thickness, fixation, registration, anesthesia workflow, radiation exposure, and age-dependent anatomy. Methods: We performed a narrative review of robotic applications in functional neurosurgery, emphasizing pediatric practice. PubMed, Web of Science, and Google Scholar were searched from inception to March 2025 using terms related to robotic and functional neurosurgery, pediatric neurosurgery, DBS, sEEG, LITT, robotic platforms, and artificial intelligence. English-language clinical studies, technical reports, reviews, and selected platform sources were included when addressing accuracy, safety, operative time, workflow, or pediatric applicability. Review findings: Platforms such as Neuromate, ROSA, Micromate, RONNA G6, ExcelsiusGPS, Sinovation Sinobot X1, Stealth Autoguide, and Cirq have been applied to stereotactic functional procedures. Evidence suggests robotic workflows can achieve accuracy comparable to conventional techniques and may reduce operative time or surgeon fatigue in selected settings. Results vary by platform, registration method, indication, study design, and population. Pediatric evidence is strongest for sEEG in drug-resistant epilepsy, while DBS and LITT remain promising but less studied. Conclusions: Robot-assisted stereotaxy may improve efficiency and precision in functional neurosurgery, especially for multiple or highly precise trajectories. Pediatric adoption requires careful consideration of age-specific anatomical and workflow factors. Further pediatric comparative studies are needed to define