Augmented Reality in Neurosurgery: A New Paradigm for Training

Abstract

Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use.

On the balance beam: facing the challenges of neurosurgical education in the third millennium

“…The neurosurgical community must persist in embracing the newer tools in neurosurgical education, such as simulations, Virtual Reality, and Hybrid conferences, even beyond the COVID-19 era, to further enhance learning in the third millennium. [ 11 , 20 , 24 ]…”

Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives

“…Nonetheless, the cost-effectiveness of using intraoperative navigation has been reported to be highly beneficial for the surgeon and hospital by reducing reoperation rates and postoperative complications [65]. One limitation of the technology is the time, cost, and educational resources needed to personalize learning environments and integrate upcoming physicians with developing technology [66,67]. The difficulties regarding adequate education and training that neurosurgery residents face globally are exacerbated by advanced technologies such as those discussed in this manuscript.…”

Intraoperative Augmented Reality for Complex Glioma Resection: A Case Report

“…In cranial neurosurgery, the use of augmented reality has predominantly been limited to preoperative visualization [15][16][17]. In particular, the technology is traditionally used prior to the start of a case in order to visualize complex anatomy in 3D.…”