Robot-assisted neurosurgery

Technological advances in the modern operating room have pushed neurosurgeons to the limits of their dexterity and sta-mina. Motion scalers and tremor filters on robots permit un-precedented precision of tool manipulation, upgrading the human hand, and closing the deftness deficit. The evolution of neurosurgical robots from stereotactic systems to hybrid sys-tems capable of both stereotaxy and microsurgery is exam-ined. The future of robot-assisted neurosurgery, including ex-panded tool sets and the prospect of semi-autonomous surgery, is discussed. The neurosurgical operating room has become an area of converging technologies that include computed tomography (CT)1-3 and magnetic reso-nance imaging (MRI),410 microscopy,11'12 naviga-tion,13-15 and refinements in instrumentation.11 Although each of these has greatly advanced the field, they have pushed contemporary neurosur-geons to the limit of their dexterity and have inun-dated them with information. The modern neurosurgical operating room has become a comprehensive digital environment.16-18 It is an opportune time for the incorporation of a robotic system to facilitate the integration of infor-mation and extend the capabilities of human sur-geons.1923 Not only will current procedures be per-formed with increased dexterity and precision, but robotics will also provide the platform for entirely new procedures. The brain is ideal for robotic incursion because it is symmetrically confined within a rigid structure and is easily damaged by slight deviations of tools.24 Because it can be rigidly fixed in space, the skull permits enhanced imaging of the brain as well as stable registration with the robot. These features