AUTHOR=Ragnhildstveit Anya , Li Chao , Zimmerman Mackenzie H. , Mamalakis Michail , Curry Victoria N. , Holle Willis , Baig Noor , Uğuralp Ahmet K. , Alkhani Layth , Oğuz-Uğuralp Zeliha , Romero-Garcia Rafael , Suckling John 

TITLE=Intra-operative applications of augmented reality in glioma surgery: a systematic review

JOURNAL=Frontiers in Surgery

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2023.1245851

DOI=10.3389/fsurg.2023.1245851

ISSN=2296-875X

ABSTRACT=Background: Augmented reality (AR) is increasingly being explored in neurosurgical practice. By visualizing patient-specific, three-dimensional (3D) models in real time, surgeons can improve their spatial understanding of complex anatomy and pathology, thereby optimizing intra-operative navigation, localization, and resection. Here, we aimed to capture applications of AR in glioma surgery, their current status and future potential.

Methods: A systematic review of the literature was conducted. This adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Embase, and Scopus electronic databases were queried from inception to October 10, 2022. Leveraging the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework, study eligibility was evaluated in the qualitative synthesis. Data regarding AR workflow, surgical application, and associated outcomes were then extracted. Levels of evidence were additionally examined, employing hierarchical classification systems for neurosurgery. This is a provisional file, not the final typeset article 

Results: The search returned 77 articles. Forty were subject to title and abstract screening, while 25 proceeded to full text screening. Of these, 22 articles met eligibility criteria and were included in the final review. During abstraction, studies were classified as 'development' or 'intervention' based on primary aims. Overall, AR was qualitatively advantageous, due to enhanced visualization of gliomas and critical structures, frequently aiding in maximal safe resection. Non-rigid applications were also useful in disclosing and compensating for intra-operative brain shift. Irrespective, there was high variance in registration methods and measurements, considerably impacting projection accuracy. Most studies were of low-level evidence, yielding heterogeneous results.

Conclusions: AR has increasing potential for glioma surgery, with capacity to positively influence the onco-functional balance. However, technical and design limitations are readily apparent. The field must consider the importance of consistency and replicability, as well as the level of evidence, to effectively converge on standard approaches that maximize patient benefit.