Extended Reality in Neurosurgery : Surgical Planning, Navigation, Education, and Patient Communication.

Extended reality (XR), encompassing virtual reality, augmented reality (AR), and mixed reality, has emerged as a transformative technology in neurosurgery. This narrative review examines the current applications of XR technologies across four major domains : surgical planning and visualization, intraoperative navigation, medical education and training, and patient/caregiver communication. The integration of artificial intelligence-based lesion segmentation with XR platforms has enabled precise three-dimensional visualization of complex intracranial pathologies. Modern AR navigation systems, utilizing both optical see-through and video see-through head-mounted displays, have demonstrated submillimeter accuracy in recent clinical studies. Educational applications of XR have shown significant improvements in anatomical understanding and surgical skill acquisition among neurosurgery trainees. Furthermore, XR-enhanced patient communication tools have improved comprehension of complex neurosurgical procedures and informed consent quality. Despite current limitations including hardware constraints, workflow integration challenges, and the need for larger validation studies, XR technologies hold substantial promise for advancing pediatric neurosurgical care. This review provides a critical analysis of current evidence, discusses the advantages and limitations of different XR modalities, and offers perspectives on future developments in this rapidly evolving field.