Redefining neurosurgery with BrainBot: MRI-compatible robot - Children's National

What if neurosurgeons could complete brain procedures with real-time continuous visualization and submillimeter robotic precision entirely inside the MRI scanner? That is the vision behind BrainBot, a first-of-its-kind MRI-compatible robotic platform developed at the Children's National Hospital Sheikh Zayed Institute for Pediatric Surgical Innovation (SZI).

Designed specifically for image-guided, minimally invasive brain interventions, BrainBot addresses a longstanding limitation in the field: the absence of a fully robotic system capable of operating safely within the MRI environment.

Why BrainBot?

MRI imaging provides superior soft-tissue clarity and avoids ionizing radiation, a critical consideration in pediatric neurosurgery. Yet most stereotactic procedures still rely on manual frames, CT-based workflows or robotic systems that cannot function inside the MRI bore. These approaches often require moving patients between rooms, interrupting imaging continuity and prolonging anesthesia time.

MRI-compatible devices do exist, but they are manually adjusted and offer limited motion, making multi-target procedures such as epilepsy surgery inefficient and technically demanding.

"We identified a critical unmet need for a robotic platform that could operate entirely within the MRI scanner," says Reza Monfaredi, PhD, principal investigator and lead inventor of BrainBot. In collaboration with co-leaders Chima Oluigbo, MD, neurosurgeon at Children's National and clinical lead, and Kevin Cleary, PhD, associate director at SZI, the team set out to develop a system capable of delivering millimetric accuracy under continuous MRI guidance.

How does BrainBot move the field forward?

BrainBot is a fully robotic, scanner-agnostic system engineered for start-to-finish procedures inside the MRI suite. Its innovations include:

• Real-time MRI guidance: Planning, targeting and confirmation occur without repositioning the patient.
• Robotic system with four degrees of freedom: Allowing flexible, precise targeting across a spherical workspace.
• Automatic needle driver with submillimeter accuracy: An air-powered automatic needle driver enables rotational and translational motion with approximately 0.5 mm precision under surgeon supervision.
• Automatic path planning: Integrated proprietary software calculates optimal trajectories while accounting for vascular and eloquent structures.
• Innovative custom 7-channel MRI head coil integration: Enhances image quality while maintaining robotic access, a capability not possible with standard diagnostic coils.
• Modular head fixation system: Designed to accommodate patients across ages and anatomies while improving workflow efficiency.

Unlike existing systems that separate imaging and intervention, BrainBot unifies them into a single, continuous process. The platform is adaptable to brain biopsy, tumor ablation, epilepsy procedures, deep brain stimulation and precision drug delivery, with particular advantages in multi-target cases requiring numerous trajectories.

Backed by NIH support, advancing toward clinical translation

Supported by a $2 million NIH R01 grant in collaboration with Children's National Research Institute and Cincinnati Children's Hospital, the BrainBot team has achieved all major preclinical milestones. A renewal application is underway as the group prepares for first-in-human trials.

By integrating robotics, advanced imaging and automated planning into a single MRI-compatible platform, BrainBot represents a meaningful evolution in image-guided neurosurgery - one designed to enhance precision, reduce workflow inefficiencies and improve safety for patients of all ages.

The technical team from Children's National includes Gang Li, PhD, Staff Scientist II, Atharva Paralikar, R&D Engineer I, Ayush Nankani, R&D Engineer II, Pavel Yarmolenko, PhD, Assistant Professor, and Nicholas Mouzakis, MRI Technologist. Subaward collaborators from Cincinnati Children's Hospital are Chuck Dumoulin, PhD, and Wolfgang Loew.