• Tim Fick, Jesse A M van Doormaal, Eelco W Hoving, Willems Peter W A PWA Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands., and van Doormaal Tristan P C TPC Department of Neurosurgery, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Neurosurgery, Clinical Neuroscience Ce.
• Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: t.fick-4@prinsesmaximacentrum.nl.
• World Neurosurg. 2021 Feb 1; 146: 179-188.

BackgroundAugmented reality neuronavigation (ARN) systems can overlay three-dimensional anatomy and disease without the need for a two-dimensional external monitor. Accuracy is crucial for their clinical applicability. We performed a systematic review regarding the reported accuracy of ARN systems and compared them with the accuracy of conventional infrared neuronavigation (CIN).MethodsPubMed and Embase were searched for ARN and CIN systems. For ARN, type of system, method of patient-to-image registration, accuracy method, and accuracy of the system were noted. For CIN, navigation accuracy, expressed as target registration error (TRE), was noted. A meta-analysis was performed comparing the TRE of ARN and CIN systems.ResultsThirty-five studies were included, 12 for ARN and 23 for CIN. ARN systems could be divided into head-mounted display and heads-up display. In ARN, 4 methods were encountered for patient-to-image registration, of which point-pair matching was the one most frequently used. Five methods for assessing accuracy were described. Ninety-four TRE measurements of ARN systems were compared with 9058 TRE measurements of CIN systems. Mean TRE was 2.5 mm (95% confidence interval, 0.7-4.4) for ARN systems and 2.6 mm (95% confidence interval, 2.1-3.1) for CIN systems.ConclusionsIn ARN, there seems to be lack of agreement regarding the best method to assess accuracy. Nevertheless, ARN systems seem able to achieve an accuracy comparable to CIN systems. Future studies should be prospective and compare TREs, which should be measured in a standardized fashion.Copyright © 2020 Elsevier Inc. All rights reserved.

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