Advancing neurosurgical practice with augmented reality: a single-center real-world case series with illustrated technical notes

OBJECTIVE The aim of this study was to evaluate the real-world application and clinical value of a head-mounted augmented reality (AR) navigation platform across a wide range of neurosurgical pathologies and procedures. METHODS In this real-world retrospective case series, the authors assessed 105 neurosurgical procedures performed by 8 neurosurgeons at a single center from January 2024 to March 2026. A head-mounted AR navigation platform (SurgicalAR, Cranial Navigation, and Spine Navigation; Medivis) was used in all procedures. Video records were available for all cases. Clinical and pathological data, surgical approaches, types of reference frames, and registration methods were systematically collected. The workflow for each surgical approach was characterized in detail. RESULTS This analysis included 105 cases (60 female, mean age 53.5). Cranial surgeries (n = 92, 87.6%) were most common, predominantly for tumors (n = 69, 65.7%), with meningioma (22.9%) and glioblastoma (19.0%) as the leading pathologies. Custom reference frames (n = 57) and surface registration (n = 93) were the most frequently used techniques in cranial navigation. In cranial tumor surgery, gross-total resection was achieved in 62 of 69 cases, supported by multimodal AR planning. In spine surgery, all 34 pedicle screws placed with the Spine Navigation system achieved a Gertzbein-Robbins grade of A. AR was also successfully applied to cerebrovascular, puncture-based, and functional surgery. CONCLUSIONS Head-mounted AR navigation was feasible across diverse procedures, but its value depended on case selection, registration reliability, and workflow. It was most useful for multimodal tumor planning, pedicle screw placement, and percutaneous interventions; conventional navigation or direct anatomical guidance remained necessary when AR accuracy or ergonomics were inadequate. These findings support AR as a significant advancement in future neurosurgical practice.