ArticleBrain & spine2026
From planning to execution: Interactive virtual-reality assisted craniotomy planning in meningioma surgery.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: In meningioma surgery, extent and accuracy of the craniotomy are vital to achieve the predefined extent of resection. We routinely integrate interactive virtual-reality (iVR) assistance into craniotomy planning. Research question: Are preoperatively iVR-planned approaches transferable to craniotomies subsequently performed in the operating room? Material and methods: We examined 83 patients surgically treated with meningiomas, where the approach strategy was preoperatively planned and demonstrated using the MagicLeap 2 or HoloLens 2. The iVR-planned approach (iVR-Group) was compared to the real craniotomy (Real-Group) by location and relative size of craniotomy, as well as position and number of burr holes. Results: When comparing the craniotomy size, the mean anterior-posterior (AP)-ratio was 0.40 in iVR-group vs 0.41 in Real-group with 17.5% mean deviation, while the mean lateral ratio was 0.45 vs 0.49 with 15.9% mean deviation.In 9.6% of procedures, a diverging number of burr holes were used, in 3.6% the position was altered from iVR-group to Real-group. In testing for equality (TOST-test) both AP and lateral-ratio deviation showed significant results: AP-ratio-deviation: p = 0.015, CI: -0.047-0.013, equivalence margin ±0.059; lateral ratio-deviation p = 0.041, CI: -0.068-0.004, equivalence margin ±0.071. The geometrical index was 0.423 for iVR group and 0.448 for Real-group. The percentage deviation between both groups was 5.9%, indicating high transferability of preoperative planning. Discussion and conclusion: With state-of-the-art iVR-planning of meningioma surgery approaches, craniotomies respecting pathological and anatomical relations and conflicts can be accurately simulated. IVR planning may mark a new level of interactive learning and strategic planning in neurosurgery.
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