Robotic Surgery in Pediatric Epilepsy : Current Evidence, Clinical Impact, and Future Directions.

Pediatric drug-resistant epilepsy remains a significant neurological challenge, with up to one-third of affected children failing to achieve seizure control with pharmacologic therapy. Surgical intervention offers the greatest likelihood of seizure reduction or freedom; however, precise localization and treatment of epileptogenic networks in pediatric patients are often complicated by multilobar onset patterns, evolving neurodevelopmental anatomy, and limitations of conventional invasive monitoring. Over the past two decades, stereoelectroencephalography (SEEG) has emerged as a preferred invasive diagnostic modality due to its minimally invasive approach, three-dimensional sampling capability, and favorable safety profile. Parallel advances in robotic stereotaxy have further enhanced the precision, efficiency, and reproducibility of electrode implantation and stereotactic interventions. Robotic assistance has expanded beyond diagnostic SEEG implantation to include stereotactic ablative therapies, such as radiofrequency thermocoagulation and magnetic resonance-guided laser interstitial thermal therapy, as well as neuromodulation procedures including deep brain stimulation and responsive neurostimulation. These technologies enable precise targeting of deep and distributed epileptogenic networks while minimizing surgical morbidity. Pediatric clinical studies demonstrate that robotic-assisted SEEG achieves high diagnostic yield, excellent safety profiles, and accuracy comparable to or exceeding conventional stereotactic techniques. Similarly, robot-assisted ablative and neuromodulation procedures show promising efficacy in carefully selected pediatric populations, although complete seizure freedom remains less common in neuromodulatory approaches. Despite increasing adoption, the pediatric robotic epilepsy surgery literature remains predominantly retrospective and heterogeneous, with limited prospective comparative data. This review synthesizes current evidence regarding robotic applications in pediatric epilepsy surgery, including SEEG implantation, stereotactic ablation, and neuromodulation. We highlight technical considerations, clinical outcomes, and safety profiles, while identifying critical gaps in evidence related to long-term outcomes, and the direct clinical impact of robotic accuracy. Continued prospective and multicenter investigations are essential to define the optimal role of robotic assistance in improving outcomes for pediatric patients with drug-resistant epilepsy.