Transforming Neurosurgery With Spatial Computing: Enhancing Intraoperative Visualization and Precision Through Augmented Reality

BACKGROUND AND OBJECTIVES: Extended reality (XR) systems have emerged as transformative tools in neurosurgery, enhancing surgical planning, procedures, and outcomes. Integrating XR into intraoperative surgical environments represents a novel frontier in this field. This technical note explores the integration of XR systems into neurosurgical operating rooms (ORs) to leverage the capabilities of spatial computing and enhance surgical ergonomic conditions. METHODS: We analyzed 3 neurosurgical cases using the Medivis surgical augmented reality (AR) platform. The Surgical AR system software coupled with a second-generation Microsoft HoloLens worn by the primary surgeon (R.D.) facilitated the overlay of surgical 3-dimensional volumes and exoscopic outputs in the surgeon's visual field. Exoscopic and endoscopic outputs were captured, streamed to the surgical AR computer, and then transmitted to the connected HoloLens for real-time manipulation and interaction by the primary surgeon. RESULTS: These cases demonstrated the ability of XR to enhance precision and visualization by overlaying real-time 3-dimensional high-resolution imaging with exoscopic and endoscopic outputs in the OR. The surgical AR platform, used with the Microsoft HoloLens, seamlessly integrated spatial computing in the OR setting, allowing the surgical team to maintain an ergonomic operating position, optimize sight lines, and reduce the OR footprint. Postoperatively, all patients recovered well without complications. CONCLUSION: Integrating wearable XR systems into neurosurgical procedures is a valuable tool that can enhance surgical precision, visualization, and ergonomics. By bringing spatial computing directly into the OR, XR systems provide an interactive view of the surgical field, thereby mitigating intraoperative risks and enhancing patient outcomes.