Enhancing Reality: A Systematic Review of Augmented Reality in Neuronavigation and Education.

OBJECTIVES: Augmented Reality (AR) is increasingly being explored as an adjunct to conventional neuronavigation systems. AR affords the ability to superimpose 3-dimensional images onto the real environment. A natural extension of this technology is to help guide neurosurgical planning and a means of stereotactic planning and guidance. Here, we review the literature on the use of augmented reality in neurosurgery with a focus on current technologies and limitations. Furthermore, we discuss this technology in the context of neurosurgical training as an educational tool. METHODS: PubMed search was performed for "augmented reality and neurosurgery" and "mixed reality and neurosurgery" from 2010. A total of 113 articles written in the last five years were retrieved, and 39 were ultimately included in the systematic review. RESULTS: The most common use of AR in neurosurgery was in cranial surgery (n = 26). Other uses included spine surgery (n = 9) and education (n = 2). Devices used for display of AR images varied as did image-to-patient registration methods and overall system accuracy. CONCLUSIONS: While various AR systems have been successfully utilized across many neurosurgical disciplines, more research is needed in order to improve accuracy in registration and to assess whether AR-assisted surgery is safe and effective for widespread adoption.