Monitor and wand–based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to “check the navigation” on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Augmented reality (AR) is poised to streamline these issues. The authors present the first reported prospective pilot study investigating the feasibility of using the OpenSight application with an AR head-mounted display to map out the borders of tumors in patients undergoing elective craniotomy for tumor resection, and to compare the degree of correspondence with MWBNS tracing.

Eleven consecutive patients undergoing elective craniotomy for brain tumor resection were prospectively identified and underwent circumferential tumor border tracing at the time of incision planning by a surgeon wearing HoloLens AR glasses running the commercially available OpenSight application registered to the patient and preoperative MRI. Then, the same patient underwent circumferential tumor border tracing using the StealthStation S8 MWBNS. Postoperatively, both tumor border tracings were compared by two blinded board-certified neurosurgeons and rated as having an excellent, adequate, or poor correspondence degree based on a subjective sense of the overlap. Objective overlap area measurements were also determined.

Eleven patients undergoing craniotomy were included in the study. Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence. Both raters agreed on the rating in all cases. AR tracing was possible in all cases.

In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning. Future studies are needed to identify strategies to improve and optimize AR accuracy.

用于无框架术中神经导航的监视器和基于棒的神经导航站 (MWBNS) 通常用于颅神经外科手术。但是，它们在时间和空间上都很麻烦。手术室必须布置在 MWBNS 周围，至少必须使用一只手来操纵 MWBNS 棒（中断双手手术技术），并且当外科医生停下来在远程监视器上“检查导航”时，手术工作流程被中断。因此，需要连续、实时、免提的神经导航解决方案。增强现实 (AR) 有望简化这些问题。

连续 11 名接受选择性开颅脑肿瘤切除术的患者被前瞻性地识别，并在切口规划时由一名外科医生进行圆周肿瘤边界追踪，该外科医生戴着 HoloLens AR 眼镜，运行向患者注册的商用 OpenSight 应用程序和术前 MRI。然后，同一名患者使用 StealthStation S8 MWBNS 进行了圆周肿瘤边界追踪。术后，两个肿瘤边界描记由两个盲法委员会认证的神经外科医生进行比较，并根据重叠的主观感觉将其评定为具有优秀、充分或差的对应度。还确定了客观的重叠面积测量值。

研究中包括 11 名接受开颅手术的患者。5个患者程序被评为具有极好的对应度，5个具有足够的对应度，1个具有差的对应性。在所有情况下，两位评分者都同意评分。在所有情况下都可以进行 AR 追踪。

在这项小型试点研究中，作者发现 AR 在神经外科手术室的工作流程中是可行的，并且是一种可行的术前肿瘤边界识别方法，用于切口规划。未来的研究需要确定提高和优化 AR 准确性的策略。