Promises and Perils of Artificial Intelligence in Neurosurgery

• Published in: Neurosurgery Vol. 87; no. 1; pp. 33 - 44
• Main Authors: Panesar, Sandip S, Kliot, Michel, Parrish, Rob, Fernandez-Miranda, Juan, Cagle, Yvonne, Britz, Gavin W
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.07.2020; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Algorithms; Artificial intelligence; Artificial Intelligence - trends; Automation; Computer-aided medical diagnosis; Forecasts and trends; Humans; Machine learning; Medical diagnosis; Medical prognosis; Methods; Nervous system; Neurosurgery; Neurosurgery - methods; Neurosurgery - trends; Neurosurgical Procedures - methods; Neurosurgical Procedures - trends; Surgery; United States; Deep learning; Surgical adjuncts; Automation; Prognostication; Diagnostics; Machine learning; Artificial intelligence
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyz471

Abstract Artificial intelligence (AI)-facilitated clinical automation is expected to become increasingly prevalent in the near future. AI techniques may permit rapid and detailed analysis of the large quantities of clinical data generated in modern healthcare settings, at a level that is otherwise impossible by humans. Subsequently, AI may enhance clinical practice by pushing the limits of diagnostics, clinical decision making, and prognostication. Moreover, if combined with surgical robotics and other surgical adjuncts such as image guidance, AI may find its way into the operating room and permit more accurate interventions, with fewer errors. Despite the considerable hype surrounding the impending medical AI revolution, little has been written about potential downsides to increasing clinical automation. These may include both direct and indirect consequences. Directly, faulty, inadequately trained, or poorly understood algorithms may produce erroneous results, which may have wide-scale impact. Indirectly, increasing use of automation may exacerbate de-skilling of human physicians due to over-reliance, poor understanding, overconfidence, and lack of necessary vigilance of an automated clinical workflow. Many of these negative phenomena have already been witnessed in other industries that have already undergone, or are undergoing “automation revolutions,” namely commercial aviation and the automotive industry. This narrative review explores the potential benefits and consequences of the anticipated medical AI revolution from a neurosurgical perspective.