Intraoperative clinical application of augmented reality in neurosurgery: A systematic review

The interest and potential use of augmented reality (AR) in several medical fields since the early 90's has increased consistently. It provides intraoperative guidance for surgical procedures by rendering visible what cannot be seen directly, possibly affecting surgical outcomes. Our objective was to conduct a systematic review of the intraoperative clinical application of augmented reality in neurosurgery, in studies published during the last five years. We carried out an electronic search in the PUBMED database using the terms "Augmented Reality" and "Neurosurgery." After exclusions, 12 published articles that evaluated the utility of intraoperative clinical applications in surgical settings were included in our review. The results evaluated involved AR technique and visualization, time, complications, projection error, and located structures. We can conclude that the neurovascular application is the most frequent type of use for AR in neurosurgery (47.3%), followed by applications in neuro-oncological pathologies (46.7%), and non-vascular and non-neoplasic lesions (5.9%). The use of AR also allows a surgeon to maintain their view on the operative site permanently, and is useful for locating structures, guiding resections, and planning the craniotomy with more precision, decreasing the risk of injury. The intraoperative application of an augmented reality system helps to improve the quality and characteristics of the surgical field image. The injection of 3D images with AR allows for the successful integration of images in vascular, oncological and other lesions without the need of look away from the surgical field, improving safety, surgical experience, or clinical outcome. However, comparative studies are still required to determine its effectiveness.