Neurosurgical Review

, Volume 40, Issue 4, pp 537–548 | Cite as

Augmented reality in neurosurgery: a systematic review

  • Antonio MeolaEmail author
  • Fabrizio Cutolo
  • Marina Carbone
  • Federico Cagnazzo
  • Mauro Ferrari
  • Vincenzo Ferrari


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.


Augmented reality Virtual reality Tumor Aneurysm Arterovenous malformation Cavernous malformation Navigation 



Dr. Meola is supported by an NIH award (R25CA089017). We sincerely thank Nina Geller, PhD, for the careful and rigorous editing of the present manuscript.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Antonio Meola
    • 1
    Email author
  • Fabrizio Cutolo
    • 2
  • Marina Carbone
    • 2
  • Federico Cagnazzo
    • 3
  • Mauro Ferrari
    • 2
    • 4
  • Vincenzo Ferrari
    • 2
    • 5
  1. 1.Department of Neurosurgery, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Translational Research and New Technologies in Medicine and Surgery, EndoCAS CenterUniversity of PisaPisaItaly
  3. 3.Department of Neurological SurgeryUniversity of PisaPisaItaly
  4. 4.Department of Vascular SurgeryPisa University Medical SchoolPisaItaly
  5. 5.Department of Information EngineeringUniversity of PisaPisaItaly

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