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P039: ARTIFICIAL INTELLIGENCE AND ROBOTICS IN SKULL BASE SURGERY: AI-DRIVEN MOTION, SAFETY, AND DEXTERITY ENHANCEMENTS
Maleeha Ahmad, MD, FACS, FRCS; UHS

Background: Robotics in skull base surgery has historically been limited by anatomic constraints, instrument dexterity, and safety concerns. Artificial intelligence (AI) integration, such as including tremor suppression of the surgeon, trajectory optimization, predictive safety boundaries, and computer vision, is redefining accessibility and feasibility at the pituitary and parasellar region.

Methods: A structured PRISMA-based review identified cadaveric, phantom, and preclinical studies published between 2020 and 2025 evaluating robotic platforms with AI-enabled functions for skull base surgery. Extracted variables included system design, AI integration, validation stage, and clinical readiness.

Results: Handheld dexterity-enhancing robots have shown expanded 360° endonasal access, with AI algorithms enabling tremor suppression, motion smoothing, and machine-learning-based trajectory optimization. Haptic-assisted drilling systems demonstrated the ability to generate AI-derived virtual fixtures from imaging datasets, creating predictive safety boundaries that reduce overshoot and force application when in proximity to the internal carotid artery and clivus. Soft-pouch robots with six degrees of freedom incorporated computer vision and adaptive AI, allowing flexible robotic arms to tailor surgical corridors to patient-specific anatomy. Systematic reviews of the current literature confirmed AI’s emerging role in robotic skull base surgery through computer vision, autonomous motion planning, and integration with navigation platforms.

Conclusion: Robotics in skull base surgery has advanced from conceptual prototypes to validated preclinical systems. AI now functions as the intelligence layer that augments surgeon expertise, enhances precision and improves patient safety. These developments position AI-enhanced robotics to support skull base surgeons in optimizing resection while preserving normal anatomy, cranial nerves, endocrine function, and quality of life. Widespread clinical integration is anticipated within the next 3–5 years.

Keywords: Artificial intelligence, Robotics, Skull base surgery, Pituitary, Haptics, Computer vision

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