Augmented and Virtual Reality in Open Neurovascular Surgery: A Systematic Review of the Literature

Innovative technologies such as augmented reality (AR) and virtual reality (VR) are increasingly utilized for teaching, training, and surgical planning in neurosurgery. This systematic review provides an overview of the literature on the application of AR and VR specifically in open neurovascular surgery.

Following PRISMA 2020, PubMed and Embase were searched from January 2000 to July 2024. Eligible designs included case series with ≥5 patients, cohort studies, and randomized controlled trials evaluating AR or VR for open neurovascular procedures (aneurysms, arteriovenous malformations, revascularization/bypass, and microvascular decompression). Given substantial heterogeneity in outcomes and methods, we performed a narrative synthesis without meta-analysis.

Of the 422 screened articles, 43 met inclusion. In all, 32 studies (74%) evaluated VR, 10 (23%) evaluated AR, and 1 (2%) evaluated both. Most involved aneurysm surgery (65%, n = 28), followed by AVMs (21%, n = 9), revascularization (16%, n = 7), and MVD (14%, n = 6). The most frequent application was surgical planning (67%, n = 29), followed by training/education (35%, n = 15), intraoperative use (23%, n = 10), and analysis/diagnostics (9%, n = 4). Where quantitative outcomes were reported, improvements most commonly involved planning accuracy, task efficiency (e.g., clip/operative time), and user-rated usefulness; patient-level outcomes were infrequently reported and variably defined.

AR and VR are promising adjuncts for teaching, training, and planning in open neurovascular surgery, with the most consistent signals in aneurysm planning. However, evidence remains heterogeneous and largely based on surrogate or subjective measures. Comparative studies using standardized clinical endpoints are necessary to define the routine clinical impact and support broader implementation in clinical practice.