title: Augmented reality in neurosurgery: a systematic review.
abstract: Neuronavigation has become an essential neurosurgical tool in pursuing minimal invasiveness and maximal safety, even though it has several technical limitations. Augmented reality (AR) neuronavigation is a significant advance, providing a real-time updated 3D virtual model of anatomical details, overlaid on the real surgical field. Currently, only a few AR systems have been tested in a clinical setting. The aim is to review such devices. We performed a PubMed search of reports restricted to human studies of in vivo applications of AR in any neurosurgical procedure using the search terms "Augmented reality" and "Neurosurgery." Eligibility assessment was performed independently by two reviewers in an unblinded standardized manner. The systems were qualitatively evaluated on the basis of the following: neurosurgical subspecialty of application, pathology of treated lesions and lesion locations, real data source, virtual data source, tracking modality, registration technique, visualization processing, display type, and perception location. Eighteen studies were included during the period 1996 to September 30, 2015. The AR systems were grouped by the real data source: microscope (8), hand- or head-held cameras (4), direct patient view (2), endoscope (1), and X-ray fluoroscopy (1) head-mounted display (1). A total of 195 lesions were treated: 75 (38.46 %) were neoplastic, 77 (39.48 %) neurovascular, and 1 (0.51 %) hydrocephalus, and 42 (21.53 %) were undetermined. Current literature confirms that AR is a reliable and versatile tool when performing minimally invasive approaches in a wide range of neurosurgical diseases, although prospective randomized studies are not yet available and technical improvements are needed.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, 02115, Boston, MA, USA. ameola@partners.org.
authors.forename: Antonio
authors.initials: A
authors.lastname: Meola
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cutolo
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Carbone
authors.affiliation: Department of Neurological Surgery, University of Pisa, Pisa, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Cagnazzo
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy.|Department of Vascular Surgery, Pisa University Medical School, Pisa, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS Center, University of Pisa, Pisa, Italy.|Department of Information Engineering, University of Pisa, Pisa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ferrari
mesh_terms: D006801:Humans; D038361:Neuronavigation / Q000295:instrumentation* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods
keywords: Aneurysm; Arterovenous malformation; Augmented reality; Cavernous malformation; Navigation; Tumor; Virtual reality