Generative AI–Assisted Medical Illustrations in Pediatric Neurosurgery: Workflows, Ethical Safeguards, and Journal Policy Considerations

Generative artificial intelligence (AI) has emerged as a transformative tool for creating high-quality visual materials in medical research and education. In pediatric neurosurgery, where ethical and legal constraints limit the use of real patient photographs, AI-assisted illustrations offer significant potential. However, concerns regarding clinical accuracy, intellectual property, and the protection of vulnerable pediatric patients necessitate rigorous oversight. We present a human-in-the-loop workflow that integrates generative AI with vector-based digital editing to produce scientifically accurate and ethically grounded medical illustrations. We reviewed current AI usage policies from major medical journals, including the International Committee of Medical Journal Editors (ICMJE) and the Journal of Korean Neurosurgical Society (JKNS). To demonstrate practical application, we developed illustrative examples for conditions such as sacral dimple, Crouzon syndrome, and Down syndrome using clinician-led sketches and AI-assisted refinement. Vector-based workflows facilitate the transformation of AI-generated raster drafts into editable, high-resolution graphics, allowing clinicians to correct "hallucinations" and ensure anatomical precision. While most journals prohibit listing AI as an author, they permit its use for conceptual figures provided there is transparent disclosure of the tools and prompts used. Our proposed workflow emphasizes that AI should function as a "constrained assistant" rather than an autonomous creator, ensuring that the final output remains non-identifiable and respectful of pediatric patients' dignity. Generative AI tools can significantly enhance visualization in pediatric neurosurgery when governed by strict ethical and technical safeguards. Adherence to journal policies and the maintenance of human-directed validation are essential to uphold scientific integrity and patient privacy in the era of AI-assisted publishing.