Ethics in Precision Neuro-Oncology: A Systematic Review of Empirical Evidence on Autonomy and Consent in AI-Guided Neurosurgery

Abstract

Background: Artificial intelligence (AI) is increasingly embedded in neurosurgical planning, intraoperative workflows, and risk prediction. These developments raise complex ethical concerns about autonomy, informed consent, trust, and responsibility, particularly in precision neuro-oncology, where surgical decisions may affect cognitive and identity-related functions. Empirical evidence on how patients and clinicians understand these issues remains limited.
Methods: A systematic search of PubMed, Embase, Scopus, Web of Science, and PhilPapers (2000–2025) identified original human-participant studies examining AI-assisted neurosurgical decision-making with relevance to autonomy, consent, trust, or responsibility. Inclusion required a neurosurgical context and empirical assessment of patient or clinician perspectives. Data extraction and quality appraisal were performed independently. Due to heterogeneity in study design, narrative synthesis was used.
Results: Six studies (≈1,400 participants) met inclusion criteria. Patients widely accepted AI for imaging support, planning, and risk stratification but rejected autonomous surgical action. Explicit disclosure of AI involvement was considered essential for informed consent. Neurosurgeons expressed optimism regarding analytical benefits yet voiced concerns about algorithmic opacity, automation bias, and medico-legal responsibility, insisting that decision-making authority remain clinician-led. A neuro-oncology–specific study showed that glioma patients may misinterpret probabilistic AI outputs, indicating vulnerability in risk comprehension.
Conclusions: Despite limited empirical literature, consistent themes emerged: AI is ethically acceptable when it augments, rather than replaces, human judgment; transparency is crucial; and neuro-oncology populations require adapted, iterative consent processes. These findings highlight the need for precision ethics alongside precision neurosurgery.