The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room.

BACKGROUND: In this era of imagination and technological innovation, mixed reality systems such as virtual reality (VR) and augmented reality (AR) are contributing to a wide array of neurosurgical care, from the betterment of surgical planning and surgical comfort to even novel treatments and improved resident education. These systems can augment procedures that require high-level dexterity such as minimally invasive surgery, tumor excisions, as well as peripheral and neurovascular surgery. Herein, the authors will define and compare the technological features, indications, and characterized outcomes of VR and AR systems in the context of neurosurgery through a review of the literature to date. Moreover, this review will discuss the limitations of VR and AR while including an overview of the cost effectiveness of each of these systems. METHODS: An extensive review of published literature on augmented reality and virtual reality was performed utilizing PubMed, OVID Medline, and EMBASE journals from January 1, 2006 to April 2, 2022. Terms used for the search included augmented reality, spinal surgery, virtual reality, and neurosurgery. RESULTS: The search yielded full text English language-related articles regarding virtual and augmented reality application, limitations, and functional outcomes in neurosurgery. An initial set of 121 studies were screened and reviewed for content. There were 13 studies included that involved 162 patients, 550 screw placements, 58 phantom spines, and learning points from simulation training of 276 involved residents. CONCLUSION: This literature review examines recent research into virtual and augmented reality applications in neurosurgical care. The literature establishes there are technological features, indications, outcomes, limitations, and cost effectiveness differences between these systems. Based on ongoing and evolving applications of the VR and AR systems, their innovative potential they make available to the future of neurosurgical patient care makes clear the need for further studies to understand the nuances between their differing technological advances