School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
Vascular Neurosurgery and Skull Base Division, Hospital Nacional Dos de Mayo, Lima, Peru.
World Neurosurg. 2024 Jul;187:114-121. doi: 10.1016/j.wneu.2024.04.048. Epub 2024 Apr 16.
Augmented reality (AR) and virtual reality (VR) technologies have been introduced to neurosurgery with the goal of improving the experience of human visualization. In recent years, the application of remote AR and VR has opened new horizons for neurosurgical collaboration across diverse domains of education and patient treatment. Herein, we aimed to systematically review the literature about the feasibility of this technology and discuss the technical aspects, current limitations, and future perspectives.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 4 databases (PubMed, Embase, Scopus, and Cochrane Library) were queried for articles discussing the use of remote AR and VR technologies in neurosurgery. Data were collected in various fields, including surgery type, application type, subspecialty, software and hardware descriptions, haptic device utilization, visualization technology, internet connection, remote site descriptions, technical outcomes, and limitations. Data were summarized as counts and proportions and analyzed using IBM SPSS software.
Our search strategy generated 466 records, out of which 9 studies satisfied the inclusion criteria. The majority of AR and VR applications were used in cranial procedures (77.8%), mainly in education (63.6%), followed by telesurgical assistance (18.2%), patient monitoring (9.1%), and surgical planning (9.1%). Local collaborations were established in 55.6% of the studies, while national and international partnerships were formed in 44.4% of the studies. AR was the main visualization technology, and 3G internet connection was predominantly used (27.5%). All studies subjectively reported the utility of remote AR and VR for real-time interaction. The major technical challenges and limitations included audiovisual latency, the requirement for higher-fidelity and resolution image reconstructions, and the level of proficiency of the patient with the software.
The results from this systematic review suggest that AR and VR technologies are dynamically advancing to offer remote collaboration in neurosurgery. Although still incipient in development and with an imperative need for technical improvement, remote AR and VR hold a frontierless potential for patient monitoring, neurosurgical education, and long-distance surgical assistance.
增强现实（AR）和虚拟现实（VR）技术已被引入神经外科领域，旨在改善人类可视化体验。近年来，远程 AR 和 VR 的应用为神经外科在教育和患者治疗等多个领域的协作开辟了新的视野。在此，我们旨在系统地回顾该技术的可行性相关文献，并讨论其技术方面、当前局限性和未来展望。
根据系统评价和荟萃分析的首选报告项目指南，我们在 4 个数据库（PubMed、Embase、Scopus 和 Cochrane Library）中查询了讨论远程 AR 和 VR 技术在神经外科中应用的文章。收集的数据涉及手术类型、应用类型、亚专业、软件和硬件描述、触觉设备利用、可视化技术、互联网连接、远程站点描述、技术结果和局限性等各个领域。使用 IBM SPSS 软件对数据进行汇总和分析，结果以计数和比例表示。
我们的搜索策略生成了 466 条记录，其中 9 项研究符合纳入标准。大多数 AR 和 VR 应用主要用于颅面手术（77.8%），主要用于教育（63.6%），其次是远程手术协助（18.2%）、患者监测（9.1%）和手术规划（9.1%）。55.6%的研究建立了本地合作，44.4%的研究建立了国家和国际合作。AR 是主要的可视化技术，主要使用 3G 互联网连接（27.5%）。所有研究均主观报告了远程 AR 和 VR 用于实时交互的实用性。主要技术挑战和局限性包括视听延迟、对更高保真度和分辨率图像重建的要求以及患者对软件的熟练程度。
本系统评价的结果表明，AR 和 VR 技术正在迅速发展，为神经外科提供远程协作。尽管仍处于发展初期，并且迫切需要技术改进，但远程 AR 和 VR 具有无限潜力，可用于患者监测、神经外科学教育和远程手术协助。
