Real-time augmented reality trajectory lines technique for deep-seated glioblastoma: Technical note

To describe a practical and reproducible technique for real-time augmented reality (AR)–guided microsurgery, achieved through direct linkage between the surgical microscope and neuronavigation system, applied to the resection of a deep-seated glioblastoma. A real-time AR visualization system was implemented by connecting a surgical microscope (ZEISS KINEVO 900) with a neuronavigation platform (StealthStation S8, Medtronic). The system dynamically projected tumor boundaries and depth-sensitive trajectory lines into the operative view, providing continuous spatial guidance without the need for additional instruments. The technique was applied during subpial dissection and resection of a deeply located frontal glioblastoma extending toward the corpus callosum. Dynamic AR trajectory lines enabled precise delineation of resection margins and depth while maintaining a seamless surgical workflow. Near-total tumor removal was achieved under direct microscopic AR visualization without introducing additional mechanical intrusion such as catheter placement or stereotactic probes. Postoperative MRI confirmed safe and effective resection, and neurological function was preserved. This technical note illustrates the feasibility and potential advantages of real-time microscope-linked AR guidance for deep-seated glioblastoma resection. The method is readily applicable in standard neurosurgical settings, requiring no specialized equipment or additional cost. Institutional review board approval was obtained, and written informed consent for the procedure and publication was secured.