Deep Ablation Research Articles

Investigation of scanning strategies on performance of nanosecond and picosecond laser volume ablation of bronze

Understanding of laser volume ablation performance in different scanning strategies is indispensable for practical applications. This study investigates the influence of different laser scanning parameters on the performance of volume ablation of bronze material. The results reveal significant differences between the selected pulse durations of 16 ns (ns) and 12 picoseconds (ps), despite both using an identical maximum average power of 40 W. In both cases, increasing the scanning area resulted in a proportional increase in ablation depth. Compared to the ns-laser, the ps-laser exhibited significantly lower ablation depths, approximately 35 % to 40 % less, with consistent performance across different scanning directions. Surface topography analysis showed that scanning direction played a crucial role in determining the final surface quality, with a nearly 50 % improvement observed with the mixed scanning strategy. With the ps-laser, expanding the scanning area led to reduced surface roughness, primarily due to pure ablation and minimal surface re-melting. Further strategies, such as interlace and halftone were also explored. Adjusting the line delay time was also considered, with longer delays potentially resulting in deeper ablation and slightly improved surface roughness. The study also investigated the pitting phenomenon, which was found to be intensified around contour edges. Notably, pitting was more pronounced in ns ablation during the initial scanning layers, while in ps ablation, pitting distribution intensified with an increase in scanning layers and ablation depth.

Long-Term Safety and Efficacy of Transcatheter Microwave and Radiofrequency Denervation in a Chronic Ovine Model.

Transcatheter renal denervation (RDN) has had inconsistent efficacy and concerns for durability of denervation. We aimed to investigate long-term safety and efficacy of transcatheter microwave RDN invivo in normotensive sheep in comparison to conventional radiofrequency ablation. Sheep underwent bilateral RDN, receiving 1 to 2 microwave ablations (maximum power of 80-120 W for 240 s-480 s) and 12 to 16 radiofrequency ablations (180 s-240 s) in the main renal artery in a paired fashion, alternating the side of treatment, euthanized at 2 weeks (acute N=15) or 5.5 months (chronic N=15), and compared with undenervated controls (N=4). Microwave RDN produced substantial circumferential perivascular injury compared with radiofrequency at both 2 weeks [area 239.8 (interquartile range [IQR] 152.0-343.4) mm2 versus 50.1 (IQR, 32.0-74.6) mm2, P <0.001; depth 16.4 (IQR, 13.9-18.9) mm versus 7.5 (IQR, 6.0-8.9) mm P <0.001] and 5.5 months [area 20.0 (IQR, 3.4-31.8) mm2 versus 5.0 (IQR, 1.4-7.3) mm2, P=0.025; depth 5.9 (IQR, 1.9-8.8) mm versus 3.1 (IQR, 1.2-4.1) mm, P=0.005] using mixed models. Renal denervation resulted in significant long-term reductions in viability of renal sympathetic nerves [58.9% reduction with microwave (P=0.01) and 45% reduction with radiofrequency (P=0.017)] and median cortical norepinephrine levels [71% reduction with microwave (P <0.001) and 72.9% reduction with radiofrequency (P <0.001)] at 5.5 months compared with undenervated controls. Transcatheter microwave RDN produces deep circumferential perivascular ablations without significant arterial injury to provide effective and durable RDN at 5.5 months compared with radiofrequency RDN.

497 Superficial MRI-guided Laser Interstitial Thermal Therapy (LITT) for Intracranial Metastasis Is Associated With a Significantly Higher Rate of Leptomeningeal Disease

INTRODUCTION: Evolving brain metastases treatment standards has led to shifting intracranial recurrence patterns, especially with respect to pachymeningeal and leptomeningeal disease (PMD/LMD). As an emerging technique, it remains unclear if the depth of magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is associated with frequency of iatrogenic PMD/LMD. METHODS: A single-institute retrospective analysis of patients who underwent LITT surgery between 2014 and 2022 was conducted to investigate the development of PMD/LMD. P-values &lt;0.05 were considered statistically significant. RESULTS: Eleven patients undergoing thirteen LITT procedures were analyzed. Mean age was 62.6 (±11.7), and 69.2% of patients were female. PMD/LMD developed in 4/13 cases (30.8%). There was no significant difference between superficial vs. deep LITT ablation in terms of age, sex, follow-up time, and primary cancer site. Superficial LITT ablation had a significantly higher frequency of PMD/LMD compared to deep LITT ablation (p = 0.02). Time to PMD/LMD development among patients who underwent superficial LITT ablation was significantly shorter compared to that among patients who had deep LITT ablation (p = 0.02). CONCLUSIONS: Superficial LITT ablation was associated with significantly higher frequency and shorter time to PMD/LMD development compared to deep LITT ablation. These results suggest that iatrogenic PMD/LMD spread during superficial LITT ablation may increase the proportion of PMD/LMD and accelerate disease timeline.

Erbium: YAG laser treatment efficacy and association with histologic features for giant congenital melanocytic nevi management.

Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN). We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response. Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment. Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05). The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.

Design and Verification of Sector Vortex Archimedean Spiral Phased Array Transducer for Improving Focus Acoustic Pressure

The emergence of high-intensity focused ultrasound applications brings great potential to establish noninvasive therapeutic treatment in place of conventional surgery. However, the development of ultrasonic technology also poses challenges to the design and manufacture of high-power ultrasound transducers with sufficient acoustic pressure. Here, the design of a sector vortex Archimedean spiral phased array transducer that is able to enhance focal acoustic pressure is proposed by maximizing the filling factor of the piezoelectric array. The transducer design was experimentally verified by hydrophone measurements and matched well with acoustic simulation studies. The focal deflection was shown to be feasible up to ±9 mm laterally and up to ±20 mm axially, where the effective focal acoustic pressure can be maintained above 50% and the level of the grating lobe below 30%. Furthermore, a homogeneous pressure distribution without secondary focus was observed in the pre-focal region of the transducer. The rational design of a high-intensity focused ultrasound transducer indicates promising development in the treatment of deep tissue thermal ablation for clinical applications.

The changing landscape of palliative epilepsy surgery for Lennox Gastaut Syndrome.

Lennox Gastaut Syndrome (LGS) is characterized by drug-resistant epilepsy that typically leads to decreased quality of life and deleterious neurodevelopmental comorbidities from medically refractory seizures. In recent years there has been a dramatic increase in the development and availability of novel treatment strategies for Lennox Gastaut Syndrome patient to improve seizure. Recent advances in neuromodulation and minimally invasive magnetic resonance guided laser interstitial thermal therapy (MRgLITT) have paved the way for new treatments strategies including deep brain stimulation (DBS), responsive neurostimulation (RNS), and MRgLITT corpus callosum ablation. These new strategies offer hope for children with drug-resistant generalized epilepsies, but important questions remain about the safety and effectiveness of these new approaches. In this review, we describe the opportunities presented by these new strategies and how each treatment strategy is currently being employed. Next, we will critically assess available evidence for these new approaches compared to traditional palliative epilepsy surgery approaches, such as vagus nerve stimulation (VNS) and open microsurgical corpus callosotomy (CC). Finally, we will describe future directions that would help define which of the available strategies should be employed and when.

257 nm Deep UV Femtosecond Laser Ablation with Minimized Crack and Chipping on Display Ultra-Thin Glass

257 nm Deep UV Femtosecond Laser Ablation with Minimized Crack and Chipping on Display Ultra-Thin Glass

Feasibility Study of Numerical Calculation and Machine Learning Hybrid Approach for Renal Denervation Temperature Prediction

Transcatheter renal denervation (RDN) is a novel treatment to reduce blood pressure in patients with resistant hypertension using an energy-based catheter, mostly radio frequency (RF) current, by eliminating renal sympathetic nerve. However, several inconsistent RDN treatments were reported, mainly due to RF current narrow heating area, and the inability to confirm a successful nerve ablation in a deep area. We proposed microwave energy as an alternative for creating a wider ablation area. However, confirming a successful ablation is still a problem. In this paper, we designed a prediction method for deep renal nerve ablation sites using hybrid numerical calculation-driven machine learning (ML) in combination with a microwave catheter. This work is a first-step investigation to check the hybrid ML prediction capability in a real-world situation. A catheter with a single-slot coaxial antenna at 2.45 GHz with a balloon catheter, combined with a thin thermometer probe on the balloon surface, is proposed. Lumen temperature measured by the probe is used as an ML input to predict the temperature rise at the ablation site. Heating experiments using 6 and 8 mm hole phantom with a 41.3 W excited power, and 8 mm with 36.4 W excited power, were done eight times each to check the feasibility and accuracy of the ML algorithm. In addition, the temperature on the ablation site is measured for reference. Prediction by ML algorithm agrees well with the reference, with a maximum difference of 6 °C and 3 °C in 6 and 8 mm (both power), respectively. Overall, the proposed ML algorithm is capable of predicting the ablation site temperature rise with high accuracy.

"Ice and Fire" Supramolecular Cell-Conjugation Drug Delivery Platform for Deep Tumor Ablation and Boosted Antitumor Immunity.

Cancer recurrence and metastasis are two major challenges in the current clinical therapy. In this work, a novel diketopyrrolopyrrole-based photothermal reagent (DCN) with unique J-aggregation-induced redshift is synthesized to achieve efficient tumor thermal ablation under safe power (0.33Wcm-2 ). Meanwhile, S-nitroso-N-acetylpenicillamine (SNAP) is co-loaded with near-infrared-absorbing DCN in amphiphilic polymers to realize heat-induced massive release of nitric oxide (NO), which can form oxidant peroxynitrite (ONOO- ) to active matrix metalloproteinases (MMPs), thereby degrading the compact tumor extracellular matrix to improve the ablation depth and infiltration of immune cells. Through a facile supramolecular assembly method, the DCN/SNAP nanoparticles are anchored to liquid-nitrogen-frozen cancer cells, achieving enhanced antitumor immune responses and effective inhibition of distant tumors and pulmonary metastases after only one treatment. The safety and effectiveness of this supramolecular cell-conjugation platform are verified by 2D/3D cellular experiments and bilateral tumor model, confirming the thermal-ablation-gas-permeation-antigen-presentation therapeutic mode has promising anticancer prospects.

Abstract 15070: Predicting Steam-Pop Incidence Using Ex-Vivo Bipolar Ablation Model of Porcine Ventricular Myocardium

Introduction: Bipolar ablation has been reported to be able to create deep myocardial ablation lesion as compared to unipolar ablation, however, the incidence of steam-pop can lead to undesirable periprocedural complication. Hypothesis: Steam-pop occurrence during bipolar ablation can be predicted by the settings of bipolar ablation and the myocardial tissue characteristics such as tissue thickness and initial impedance prior to RF. Methods: Using porcine cardiac tissues ex-vivo ablation experiments were conducted. We adopted the commercially available radiofrequency (RF) ablation catheters. Each ablation catheter was placed on both sides of the myocardial slice at an angle of 45 degrees under targeted contact force of 10g. We recorded the occurrence of steam-pop under the multiple settings of tissue thickness, RF power and ablation duration. We created a generalized linear model (GLM) to predict steam-pop based on the bipolar ablation settings and the myocardial tissue characteristics. Results: In total 194 bipolar applications were analyzed. Steam-pops were observed in 11 out of 194 applications (5.7%). In the applications with steam-pop, the RF energy was higher (median 40W [q1-q3: 30-50] vs 30W [20-40], P=0.017), the initial impedance was lower (88 [86.75 - 91.5] vs 93 Ohm [89.75 - 95.75], P=0.0042) and the tissue thickness was thinner (9.4 [8.43 - 9.89] vs 12.9 mm [10.06 - 15.47], P&lt;0.0001) as compared to the applications without steam-pop. Using tissue thickness, RF energy and initial impedance, the constructed GLM achieved sensitivity of 100%, specificity of 93% and the area under the receiver-operator-characteristics curve of 0.969. Conclusion: Our data showed that the steam-pop occurrence during bipolar ablation may be predicted based on the initial RF settings and the tissue characteristics in the ex-vivo porcine myocardial model. Further studies are necessary to validate the feasibility of predicting steam-pops using the RF and tissue characteristics in the beating heart and human heart, which may enable us to titrate the RF settings and lead to safer bipolar ablation.

Effect of Laser-Textured Cu Foil with Deep Ablation on Si Anode Performance in Li-Ion Batteries.

Si is a highly promising anode material due to its superior theoretical capacity of up to 3579 mAh/g. However, it is worth noting that Si anodes experience significant volume expansion (>300%) during charging and discharging. Due to the weak adhesion between the anode coating and the smooth Cu foil current collector, the volume-expanded Si anode easily peels off, thus damaging anode cycling performance. In the present study, a femtosecond laser with a wavelength of 515 nm is used to texture Cu foils with a hierarchical microstructure and nanostructure. The peeling and cracking phenomenon in the Si anode are successfully reduced, demonstrating that volume expansion is effectively mitigated, which is attributed to the high specific surface area of the nanostructure and the protection of the deep-ablated microgrooves. Moreover, the hierarchical structure reduces interfacial resistance to promote electron transfer. The Si anode achieves improved cycling stability and rate capability, and the influence of structural features on the aforementioned performance is studied. The Si anode on the 20 μm-thick Cu current collector with a groove density of 75% and a depth of 15 μm exhibits a capacity of 1182 mAh/g after 300 cycles at 1 C and shows a high-rate capacity of 684 mAh/g at 3 C.

Modified Hierarchical-Attention Network model for legal judgment predictions

The impact of Artificial Intelligence in Legal Research has reached a high level in simulating human thought processes. Case Pendency is a long-lasting problem in many countries. The judicial system has to be more competent and reliable to provide justice on time for any developing country. Litigants and attorneys devote more time and effort to trial case preparation in the courtroom. The task of decision prediction is to automatically forecast the type of charge, law article, and term of punishment. Most of the earlier works for verdict prediction focused to work on civil law jurisdictions. Some of the challenges in the task are case facts are highly unstructured lengthy documents with a lack of annotations and mainly used machine learning techniques. While most research works ignore the information loss at the encoding stage, our proposed MHAN overcomes the above issue and long-range dependency problem using the attention model over hierarchical encoders with three tiers namely Sentence encoder, word encoder, and character encoder. To avoid information loss, a brand-new judgment prediction framework called MHAN is developed in this study effort. It is built on a modified Hierarchical-Attention network and a specially designed domain-specific word embedding model. Additionally, it emphasizes the feature extraction phase by joining features obtained using MHAN with an improved cosine similarity feature. Finally, a hybrid Self Improved RNN is employed to provide the projected results. Furthermore, the proposed model is trained on 10 types of real-time criminal cases from the Madras High Court of India and Supreme Court of India. It has outperformed prior methods in terms of verdict prediction. By applying different variations of the deep learning model and ablation tests, the proposed model achieves consistent results over baseline models.

P-wave morphology variants in patients with interatrial block visualized using CineECG: A new classification approach

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

The CineECG in repolarization abnormalities due to myocardial ischemia

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

CineECG for visualization of changes in ventricular activation and repolarization during ischemia

High-intensity focused ultrasound (HIFU) can achieve accurate and focused deep tissue ablation through an extracorporeal emission. Cardiac ablation using HIFU applied transthoracically must overcome potential interference from intervening thoracic structures. The aim of this study was to explore the efficacy and safety of septal ablation that was induced using transthoracic HIFU.Twenty-one canines were pretreated to improve acoustic transmission. Single ablations were induced by targeting transthoracic HIFU with acoustic power of 400 W for 3 sec at the middle and basal septum in eight canines. Extended ablations were performed to create larger lesions at the basal septum in eight more canines. The three-dimensional morphology of a basal septum lesion induced by a single ablation was analyzed. The temperature at the ablative targets was measured in the other five canines.The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The three-dimensional morphology of the lesions appeared approximately as ellipsoids with a flatter endocardial side. The peak temperature at a power of 400 W for 3 sec was 93.27 ± 2.54°C, and it remained >50°C for nearly 10 sec. No procedure-related complications were observed.Ultrasound-guided transthoracic HIFU has the potential to safely create small dot or large mass lesions in the septum without a thoracotomy or a catheter.

Demonstration of object location, classification, and characterization by developed deep learning dust ablation trail analysis code package using plasma jets.

Based on deep learning, a Dust Ablation Trail Analysis (DATA) code package is developed to detect dust ablation trails in tokamaks, which is intended to analyze a large amount data of tokamak dusts. To validate and benchmark the DATA code package, 2440 plasma jet images are exploited for the training and test of the deep learning DATA code package, since plasma jets resemble the shape and size of dust ablation clouds in tokamaks. After being trained by 1920 plasma jet images, the DATA code package is able to locate 100% plasma jets, classify plasma jets with the accuracy of >99.9%, and output image skeleton information for classified plasma jets. The DATA code package trained by the plasma jet images is also used to analyze the dust ablation trails captured in the Experimental Advanced Superconducting (EAST) tokamak with the satisfactory performance, further verifying its applicability in the fusion dust ablation investigation. Based on its excellent performance presented here, it is demonstrated that our DATA code package is able to automatically identify and analyze dust ablation trails in tokamaks, which can be used for further detailed investigations, such as the three-dimensional reconstruction of dusts and their ablation trails.

Visual outcomes and recurrence rate of macular corneal dystrophy following phototherapeutic keratectomy in Saudi Arabia.

The purpose of the study was to evaluate the visual outcomes and recurrence rate of patients with macular corneal dystrophy (MCD) who have undergone phototherapeutic keratectomy (PTK). This retrospective, single-centered study enrolled patients from King Khaled Eye Specialist Hospital who had undergone PTK for MCD between 2000 and 2020. Pre-, intra-, and post-operative data were collected, and the primary outcome measures included uncorrected visual acuity, best-corrected visual acuity (BCVA), spherical equivalent, central keratometry, keratometric astigmatism, recurrence rate, and necessity of subsequent surgery. This study evaluated 42 eyes of 29 patients. BCVA improved from 0.41 (±0.17) preoperatively to 0.30 (±0.16) postoperatively. Sixteen out of 42 eyes (38%) had the recurrence of macular dystrophy deposits within the stroma; the average time from PTK to recurrence was 37 months (range: 5.5-115.4 months). The overall success rate of PTK at 2 years was 44.8%. Eleven eyes (26%) required subsequent surgery following PTK at an average of 43 months postoperatively. Deeper ablation and longer application of mitomycin C (MMC) were both found to be statistically significant factors associated with visual improvement and lower recurrence rate following PTK. PTK can be considered a treatment modality for younger patients to defer keratoplasty to a later stage. Deeper ablation is associated with improved postoperative visual acuity, and longer application of MMC is associated with lower recurrence rates of MCD.

Bile duct radiofrequency ablation for a residual adenoma after endoscopic papillectomy.

For residual or local recurrence of duodenal ampullary adenoma after endoscopic papillectomy, argon plasma coagulation (APC) has been reported to be useful; however, APC may be insufficient because deep or circumferential ablation in the distal bile duct is difficult to perform [1]. Recently, the usefulness of bile duct radiofrequency ablation (RFA) for residual adenomas has been reported, but the number of cases is still relatively small [2] [3]. We report a case in which bile duct RFA was performed on a residual adenoma after endoscopic papillectomy.

Bone ablation using a Ho:YAG laser

Abstract This study aimed to optimize the ablation depth and duration at a fixed energy using a Ho:YAG laser, considering fiber delivery applications. According to the measurements performed with an optical coherence tomography system, we obtained depths of about 1.4 mm with 500 mJ/pulse applied energy when moving the laser along a 1 cm line for 60 s (corresponding to ~50 pulses per position). Coupling this laser into a flexible fiber (θ= 250 μm) will be the next step for future minimal-invasive bone ablation trials. Furthermore, deeper ablation (~1.5 mm) was also achieved with different energy levels on bone samples.

Robotics in neurosurgery: Current prevalence and future directions.

Background: The first instance of a robotic-assisted surgery occurred in neurosurgery; however, it is now more common in other fields such as urology and gynecology. This study aims to characterize the prevalence of robotic surgery among current neurosurgery programs as well as identify trends in clinical trials pertaining to robotic neurosurgery.Methods: Each institution’s website was analyzed for the mention of a robotic neurosurgery program and procedures. The future potential of robotics in neurosurgery was assessed by searching for current clinical trials pertaining to neurosurgical robotic surgery.Results: Of the top 100 programs, 30 offer robotic cranial and 40 offer robotic spinal surgery. No significant differences were observed with robotic surgical offerings between geographic regions in the US. Larger programs (faculty size 16 or over) had 20 of the 30 robotic cranial programs (66.6%), whereas 21 of the 40 robotic spinal programs (52.5%) were at larger programs. An initial search of clinical trials revealed 223 studies, of which only 13 pertained to robotic neurosurgery. Spinal fixation was the most common intervention (six studies), followed by Deep Brain Stimulation (DBS, two studies), Cochlear implants (two studies), laser ablation (LITT, one study), and endovascular embolization (one study). Most studies had industry sponsors (9/13 studies), while only five studies had hospital sponsors.Conclusion: Robotic neurosurgery is still in its infancy with less than half of the top programs offering robotic procedures. Future directions for robotics in neurosurgery appear to be focused on increased automation of stereotactic procedures such as DBS and LITT and robot-assisted spinal surgery.