Virtual and augmented reality in neurosurgical training: a systematic review and meta-analysis

Virtual reality (VR) and augmented reality (AR) are increasingly used in neurosurgical education, but their educational effectiveness remains uncertain. We conducted a systematic review and meta-analysis comparing VR/AR-based neurosurgical training with conventional training methods. Outcomes were reclassified into educational domains, including learner satisfaction or perceptions, knowledge acquisition, technical skills, and objective operative performance among medical students, interns, residents, and other healthcare trainees. Eight studies were included, comprising five VR studies and three AR studies. The revised synthesis did not calculate or present a single global pooled VR estimate because the included studies measured conceptually different educational constructs. Study-level estimates showed that the direction, magnitude, precision, and certainty of evidence varied by outcome domain, comparator condition, measurement method, and participant level. The AR evidence remained small and imprecise; therefore, the non-significant AR result was interpreted as inconclusive rather than as evidence of equivalence or absence of benefit. Current evidence is insufficient to confirm a reliable educational advantage of either VR or AR in neurosurgical training. Larger, prospectively registered, methodologically standardized trials using comparable outcome measures and longer follow-up are needed before firm conclusions can be drawn.