Review of Robotic Technology for Keyhole Transcranial Stereotactic Neurosurgery

Stereotactic apparatus to guide surgical devices started being researched in 1908, yet today’s neurosurgery still rely on stereotactic frames developed almost half a century ago. Robots excel at handling spatial information and thus are an obvious candidate for guiding instrumentation along precisely planned trajectories. In this review, we introduce the concept of stereotaxy and we then describe standard Deep Brain Stimulation (DBS) surgery. Neurosurgeons’ expectations and demands about the role of robots as assistive tools are also addressed. We listed and critically reviewed the most successful robotic systems developed specifically or enabled for keyhole transcranial stereotactic neurosurgery. A comprehensive summary details the strengths and drawbacks of each robotic system, emphasising the differences between them. Finally, a critical analysis is made about the listed robotic systems’ common and distinct features, and whether they are considered advantages or not. Some essential yet not so obvious characteristics of these systems are also described, along with future perspectives. In the end, all robotic systems follow a very similar and structured workflow despite the technical differences that set them apart. No system unequivocally stands out as an absolute best. Technological progress trend is pointing towards the development of miniaturised, cost-effective solutions with more intuitive interfaces.