Objective:

To analyze the emerging ethical and regulatory challenges associated with cognitive enhancement BCIs in neurosurgical practice.

Background:

Brain–computer interfaces (BCIs) are redefining the landscape of neurosurgical innovation. Initially developed to restore motor or communication functions, BCIs are increasingly directed toward cognitive enhancement, aiming to augment memory, attention, and decision-making. This transition from therapeutic restoration to cognitive augmentation introduces complex ethical and regulatory questions concerning autonomy, identity, safety, and equitable access, necessitating structured ethical and policy responses within neurosurgery.

Design/Methods:

A narrative review was conducted using PubMed, IEEE Xplore, and ClinicalTrials.gov to identify literature and policy documents published between 2018 and 2025. Search terms included brain–computer interface, cognitive enhancement, neurosurgery, ethics, and regulation. Relevant sources were screened for neurosurgical or enhancement contexts. Thematic analysis identified recurring ethical and governance domains. Policy statements from the FDA, WHO, and OECD were also reviewed to evaluate current regulatory perspectives.

Results:

Therapeutic BCI studies demonstrate consistent restoration of motor or communication function with acceptable procedural risk. In contrast, enhancement-oriented research reveals persistent uncertainty regarding informed consent, agency, identity, and post-implant monitoring. Five key ethical domains emerged: (1) autonomy and agency, (2) informed consent under altered cognition, (3) identity and authenticity, (4) data privacy and neurosecurity, and (5) professional accountability. Policy analyses expose ongoing governance gaps, particularly related to liability, data ownership, and equitable access to enhancement technologies.

Conclusions:

BCIs mark a paradigm shift as neurosurgery moves beyond repair toward cognitive augmentation. Sustainable progress demands that ethical and regulatory frameworks evolve in parallel with innovation. Future priorities should include robust neuroethical guidelines, transparent informed consent for enhancement applications, standardized long-term follow-up, and neurosurgeons’ active leadership in policy development—ensuring responsible, equitable, and trustworthy integration of cognitive augmentation into clinical practice.