AANS Neurosurgeon | Volume 29, Number 2, 2020


Improvements through Augmented Reality

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Augmented reality (AR), or the superimposition of computer generated sensory input on the real world, and Virtual reality (VR), the complete sensory immersion in a computer generated world, are powerful technologies that will be progressively woven into our lives. Although still some years away from actualization, VR and AR will transform: (1) the operating room; (2) all of the platforms for neurosurgical education; and (3) the lives and rehabilitation of our patients. In the operating room, VR platforms are already being designed and beta tested against tried and true stereotactic systems and microscope-integrated AR is already in use in neurosurgery. Multiple atlases of neuroanatomy are now available with VR goggles to study at any time of day and from any angle. Complex skull base operations can be experienced and performed virtually layer by layer. A stroke patient, unable to travel due to an injury, will be able to experience the outside world through VR. It is conceivable that VR will be an important component of rehabilitation. 

In the operating room, AR is utilized when an MRI or cerebral angiogram is integrated into a surgeon’s microscope to help guide microsurgical technique. A desirable technological advance would be one that allows a surgeon to visualize the “unseen” throughout an operation – Cranial Nerve III encased in tumor, dorsal basilar artery perforators in a pterional approach or encased vasculature in a sphenoid wing meningioma. 

The applications for education are spectacular. For medical students and residents, surgical atlases exist that allow for general and neuroanatomy to be seen from any angle, at anytime and anywhere. In the future, immersive operating rooms will enable the surgeon to virtually perform an operation. The ability to virtually perform an operation a priori would be a life-long learning tool that benefits neurosurgeons and patients. It is anticipated that this tool will lead to increased safety and improved outcomes. For the patient, VR is a tool that could be utilized to obtain informed consent. 

Finally, in the post-surgical and rehabilitation arena, stroke patients that are immobilized from their injuries can use VR in two areas that can add significantly to quality of life.

  • There is a nascent effort to see if current technologies can aid in stroke rehabilitation of motor function and neglect.
  • For the immobilized patient, the ability to play games in an immersive space, to swim in the ocean or travel to places that would be impossible to reach may increase the quality of life.

Over the coming decades, AR and VR will profoundly change the personal and professional lives of neurosurgeons. The field is positioned to help design and implement AR and VR tools that will improve patients’ lives.


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