Augmented Reality in Neurosurgery, State of Art and Future Projections. A Systematic Review

Abstract

BackgroundThe use of augmented reality (AR) is growing in medical education, in particular, in radiology and surgery. AR has the potential to become a strategic component of neurosurgical training courses. In fact, over the years, there has been a progressive increase in the application of AR in the various fields of neurosurgery. In this study, the authors aim to define the diffusion of these augmented reality systems in recent years. This study describes future trends in augmented reality for neurosurgeons.MethodsA systematic review of the literature was conducted to identify research published from December 1st, 2011 to November 30th, 2021. Electronic databases (PubMed, PubMed Central, and Scopus) were screened. The methodological quality of studies and extracted data were assessed for “augmented reality” and “neurosurgery”. The data analysis focused on the geographical distribution, temporal evolution, and topic of augmented reality in neurosurgery.ResultsA total of 198 studies have been included. The number of augmented reality applications in the neurosurgical field has increased during the last 10 years. The main topics on which it is mostly applied are spine surgery, neuronavigation, and education. The geographical distribution shows extensive use of augmented reality in the USA, Germany, China, and Canada. North America is the continent that uses augmented reality the most in the training and education of medical students, residents, and surgeons, besides giving the greatest research contribution in spine surgery, brain oncology, and surgical planning. AR is also extensively used in Asia for intraoperative navigation. Nevertheless, augmented reality is still far from reaching Africa and other countries with limited facilities, as no publications could be retrieved from our search.ConclusionsThe use of AR is significantly increased in the last 10 years. Nowadays it is mainly used in spine surgery and for neurosurgical education, especially in North America, Europe and China. A continuous growth, also in other aspects of the specialty, is expected in the next future.

Use of Neuronavigation and Augmented Reality in Transsphenoidal Pituitary Adenoma Surgery

“…AR support can also assist in education and training of residents and less-experienced surgeons allowing for training and practice on the one hand outside of the OR but also on the other hand during surgery [ 8 ] providing especially in case of transsphenoidal approaches an improved and eased surgical orientation also in “straightforward” cases, allowing for a mental mapping of surgical trajectory, surgical field, intraoperative landmarks, and image data.…”

“…Injecting overlays of additional information in the optical image of the operating microscope thereby formed the basis for the development of new neurosurgical AR devices and finally commercialization of head-up display (HUD) microscopes in the 1990s, introducing microscope-based AR to the broad neurosurgical community [ 3 , 4 ]. Initially, AR was most often applied in cranial neurosurgery using neuronavigation and thus allowing for a real-time AR visualization of additional information such as outlined lesions or risk structures [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. With the broader availability of state-of-the-art operating microscopes, this technique was also applied in skull base and transsphenoidal surgery [ 13 , 14 , 15 , 16 , 17 , 18 ].…”

Advances and Innovations in Ablative Head and Neck Oncologic Surgery Using Mixed Reality Technologies in Personalized Medicine

“…Multiple data from different categories (such as preoperative and/or intraoperative MRI, CT, etc.) can simultaneously be captured [ 16 , 17 , 18 ].…”

Augmented and virtual reality usage in awake craniotomy: a systematic review

“…Neurosurgery has always been at the forefront of incorporating technological advances to better surgical management, with the incorporation of augmented reality (AR) and virtual reality (VR) in recent years [5,59,82]. 3-D AR and VR assist with complex neurosurgical procedures in training neurosurgeons, planning surgeries, and helping with patient recovery following the surgery, respectively through projection of virtual content in the real world and generating a 3-D environment where users can fully immerse themselves [5,82].…”