Microvascular Anastomoses and Beyond: Exploring the Role of Robotic Systems in Microneurosurgery.

Robotic assistance has evolved from an experimental concept to an established platform across several surgical disciplines. In microsurgery, dedicated robotic systems have demonstrated feasibility, precision, and reproducibility in performing microvascular anastomoses, nerve coaptations, and lymphatic procedures in reconstructive surgery. In contrast, the adoption of robotics in cranial neurosurgery remains limited, with current clinical applications largely restricted to stereotactic, frame-based procedures such as Deep Brain Stimulation and Stereo-electroencephalography, rather than active microsurgical manipulation of brain, vessels and nerves intracranially. Microsurgical robotic platforms provide technical features including motion scaling, tremor filtration, wristed micro-instrumentation, and improved ergonomics, which closely align with the demands of neurosurgical tasks requiring sustained submillimetric precision on intracranial very small structures even in constrained or eloquent anatomical regions. In this mini-review, we integrate established evidence from robotic-assisted microsurgery to explore the translational potential of these systems in cranial microneurosurgery. Particular attention is given to intracranial microvascular anastomoses as a clinically appropriate entry point, due to the characteristics of the extracranial–intracranial bypass procedures. Also, the dissection of superficial tumors and their arachnoidal planes is considered a potential application, where precision and surgeon endurance outweigh operative speed. Existing evidence remains largely preclinical or exploratory, and robust clinical data are scarce. Further development of neurosurgery-specific instrumentation, optimized workflow integration, and dedicated preclinical and clinical studies are required to define the safety, indications, and potential benefits of robotics in microneurosurgery.