Utility of robot-assisted frameless neurosurgical biopsies - scoping review of current trends

Background Intracranial brain biopsies are essential for obtaining representative tissue from not resectable intracranial lesions and determining histopathological diagnosis. While frame-based techniques have traditionally been the standard for their high accuracy, frameless robot-assisted biopsy techniques are gaining traction. This scoping review aims to evaluate the current landscape of frameless robotic neurosurgical stereotactic brain biopsies. Methods A scoping review was conducted by searching PubMed and Web of Science using search terms related to robot-assisted neurosurgical biopsies. The initial search was performed 2024–11-14 and re-performed 2026-02-10. Through the Rayyan.ai platform authors independently screened the titles and abstracts in a blinded manner. Following the unblinding, the full texts of potentially relevant studies were evaluated, and decisions were discussed collaboratively. Data extraction was carried out, and final inclusion was confirmed. Results In total 50 articles were eligible for inclusion, including data from both adult and pediatric populations. Diagnostic yield was between 84.0%–100.0%. Robotic systems were associated with similar complication rates compared to frame-based biopsy techniques. The most frequently observed adverse event being asymptomatic intracerebral hematomas with some studies showing numbers up to 40.9%. Mortality after robot-assisted stereotactic biopsies spans from 0.3 to 4.6%, with most deaths stemming from rapid tumor progression. Conclusion Frameless robot-assisted stereotactic brain biopsy systems have emerged as a valuable technique in the neurosurgical toolbox. These advanced systems offer a high diagnostic yield, flexible workflows, and non-inferiority compared to frame-based methods. Integration of intraoperative tissue examination, artificial intelligence for optimal trajectory planning and advances in non-invasive radiological methods can possibly further enhance safety and efficacy in future applications.