Augmented reality in intracranial meningioma surgery: report of a case and systematic review.

Augmented reality (AR) is as a useful and reliable tool in cranial surgery. We report the case of a left fronto-temporal meningioma in contact with the left Sylvian bifurcation, managed surgically with the aid of AR. We complete the picture with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Preoperatively, a careful segmentation of the tumor and the neighboring vessels was performed using our AR navigation software. A left fronto-temporal craniotomy was performed. Using the augmented optics technology, AR images injected into the microscope binocular during the surgery, allowed easy identification of the MCA branches and bifurcation. A systematic review of the literature was performed according to the PRISMA-P guidelines. A Simpson I resection was obtained, with no new neurological deficit and an uneventful recovery after surgery. The literature review identified eight separate articles published between 1998-2019, totaling 20 meningiomas surgically managed with the use of AR. Different AR systems are described in neurosurgery, with their respective advantages and disadvantages. Augmented optics allow the surgeon to focus on the procedure. No systematic data on postoperative radiological and clinical outcome were reported. The use of AR in meningioma surgery might help surgeons when confronted to lesions surrounded by complex structures. However, little data is available so far to support its routine use.