In Reply: Navigated Intraoperative Ultrasound Offers Effective and Efficient Real-Time Analysis of Intracranial Tumor Resection and Brain Shift

To the Editor: We thank Dr Villegas-Gomez et al2 for their interest in our recent publication1 and thoughtful letter reflecting on potential applications of augmented reality (AR) to navigated intraoperative ultrasound (iUS). Like navigated iUS, AR is an emerging and valuable tool to augment education, training, and potentially surgical planning.3-5 Combining the 2 technologies may potentiate their impact by updating AR with live, real-time anatomic models obtained regularly throughout a surgery from navigated iUS after tissue deformation and brain shift. Dr Villegas-Gomez raised an important point regarding incorporating iUS with AR in neurosurgical education. AR has emerged as a promising educational tool by expanding anatomic visualization and realistic simulation experiences for trainees to understand anatomy and refine their surgical approaches.6,7 Integrating AR with navigated iUS may enhance trainees' perspectives as they understand and approach surgical procedures through the lens of an ability to look past what the visual eye can appreciate with tools like ultrasound. Curating AR libraries of anatomic models, surgical approaches, and techniques throughout a procedure could incorporate iUS and depict the ability and tools to visualize surgeries at various stages rather than relying solely on preoperative MRI-based models and postoperative imaging to confirm the surgical procedure. Navigated iUS is a novel and exciting technology advancing neurosurgery, augmenting neurosurgical training, and improving surgical decision making and, therefore, patient outcomes. These innovations offer intriguing combinations to maximize their potential and overcome limitations. Further studies should continue analyzing the benefits of these new technologies as they are applied to an increasing range of conditions and surgeries. We once again thank Dr Villegas-Gomez et al for their thoughtful contributions and look forward to a future of integrated technology improving neurosurgical training and practice.