Robotic assistance has significantly improved the outcomes of open microsurgery and rigid endoscopic surgery, however is yet to make an impact in flexible endoscopic neurosurgery. Some of the most common intracranial procedures for treatment of hydrocephalus and tumors stand to benefit from increased dexterity and reduced invasiveness offered by robotic systems that can navigate in the deep ventricular system of the brain. We review a spectrum of flexible robotic devices, from the traditional highly actuated approach, to more novel and bio-inspired mechanisms for safe navigation. For each technology, we identify the operating principle and are able to evaluate the potential for minimally invasive surgical applications. Overall, rigid-type continuum robots have seen the most development, however, approaches combining rigid and soft robotic principles into innovative devices, are ideally situated to address safety and complexity limitations after future design evolution. We also observe a number of related challenges in the field, from surgeon-robot interfaces to robot evaluation procedures. Fundamentally, the challenges revolve around a guarantee of safety in robotic devices with the prerequisites to assist and improve upon surgical tasks. With innovative designs, materials and evaluation techniques emerging, we see potential impacts in the next 5--10 years.

翻译：机器人辅助已显著改善了开放式显微手术和刚性内镜手术的预后，然而在柔性内镜神经外科中尚未产生实质性影响。一些最常见的颅内手术（如治疗脑积水和肿瘤）有望受益于机器人系统提供的更高灵活性和更小创伤性——这些系统能够在大脑深部脑室系统中导航。我们综述了一系列柔性机器人装置，从传统的高度致动方法，到更具创新性的仿生安全导航机制。针对每种技术，我们阐明其操作原理，并评估其在微创外科应用中的潜力。总体而言，刚性连续体机器人已获得最多发展，然而，将刚性和软体机器人原理结合到创新装置中的方法，经过未来设计改进后，最有望解决安全性和复杂性限制。我们还观察到该领域若干相关挑战，从外科医生-机器人接口到机器人评估流程。从根本上说，这些挑战围绕如何在具备辅助和改进手术任务前提的机器人装置中保障安全性。随着创新设计、材料和评估技术的涌现，我们预见到未来5-10年内的潜在影响。