The ExcelsiusGPS (Globus Medical, Inc., Audubon, PA) robot received clearance from the United States Food and Drug Administration for clinical use in 2017 with the first in human use for lumbar spine instrumentation at Johns Hopkins Hospital the same year. The applications of the robot soon expanded with the first interbody cage placement in 2020 and first deep brain stimulation performed in 2021. A metanalysis by Kosmopoulos et al1 found that of 37,337 pedicle screws implanted by freehand, 34,107 (91.3%) were found to be placed accurately. Furthermore, there was a higher rate of accuracy in the navigation group (95.2%) compared to without navigation (90.3%). Initial studies with the ExcelsiusGPS robot reported successful lumbar pedicle screw placement rate of 97.4% (339/348)2 and 99% (555/562).3 The ExcelsiusGPS robot has been shown to increase screw placement accuracy enabling utilization of longer screw length and diameters, reduce radiation exposure and surgical time.4 While conventional uses of the robot in spine surgery are pedicle screw placement and sacroiliac fusion, newer navigated interbody placement software hopes to minimize spinal cord injury during interbody placement. Current use in cranial surgery include biopsy, deep brain stimulation, and stereoelectroencephalography (sEEG). High cervical fixation involving C1 and C2 is a complex surgery with potentially severe complications including screw malposition causing damage to neural and/or vascular structures. In a study evaluating the accuracy of free-hand technique of C2 pars screw placement, 11% of screws were mispositioned using the cortical-breach grading system5. Among high cervical transarticular screws, the most common complication included screw misposition at 7% while vertebral artery injury occurred in about 3% of patients6. It was noted that anatomic constraints for this procedure involve alignment of C1 and C2 while inadequate reduction of C1 and C2 contributed to screw misposition. Due to these complications, higher accuracy is needed. Common complications of depth electrode placement for sEEG are hemorrhage related (eg: subdural hematoma, epidural hematoma or intracerebral hemorrhage) and hardware related complications such as malpositioning, electrode fracture, or electrode-recording malfunction7. Robotic navigation aims to reduce these events and increase accuracy. Here we report the first case series of high cervical fixation and sEEG depth electrode placement using the ExcelsiusGPS robot.