From experimental to essential: The evolving role of augmented reality in neurosurgery (2012-2024)

Recent years have seen augmented reality (AR) transition from experimental to clinical practice. Advancements in hardware, software, and its integration with complementary technologies such as machine learning and robotics have improved its workflow and integration into the neurosurgical environment. This systematic review evaluates shifts in trends in AR adoption in neurosurgery from 2022 to 2024. A systematic review of PubMed was conducted following PRISMA guidelines. Studies published between January 2022 and December 2024 that had direct clinical or educational applications were included. Extracted data included the clinical context and geographical context from each study, and was analyzed with data from a previous systematic review from 2012 to 2021 to assess research evolution. A total of 275 new studies were identified, revealing a substantial increase in AR-related publications. Research trends have shifted towards more clinical embedded topics, particularly centered around neuronavigation (101), education (87), and spinal surgery (70), with the subspecialties exhibiting the most growth being spinal surgery, vascular surgery and neuro-oncology. Research output remained concentrated in high-income countries, led by the United states (53%), Switzerland (18.55%) and the UK (9.45%), reinforcing an expanding global disparity. Topic clustering analysis identified education as a central point of focus across subspecialties. As AR continues to become increasingly integrated within the neurosurgical workflow, future research should emphasize standardizing its clinical implementation and addressing global disparities in access and adoption.