What question did this study set out to answer?

This study evaluates the effectiveness of augmented reality in enhancing understanding during preoperative risk communication in neurosurgery.

April 19, 2026Open Access

The Real-Time Support Role of Augmented Reality Technology in Shared Decision-Making in Neurosurgery Under the SEGUE Framework: Randomized Controlled Trial

Puntos clave

This study evaluates the effectiveness of augmented reality in enhancing understanding during preoperative risk communication in neurosurgery.
Conducted a single-center, randomized controlled trial with 62 communication recipients.
Participants were randomized into augmented reality and physical model groups based on planned surgical approach.
Primary outcome measured objective understanding using a multiple-choice questionnaire.
Objective understanding was significantly higher in the augmented reality group (P=.01).
Communication satisfaction was notably better with augmented reality (P<.001).
No significant differences between groups for subjective understanding, anxiety changes, or communication duration.

Resumen

Background Preoperative risk communication is essential for shared decision-making (SDM) in neurosurgery; however, conveying complex neuroanatomy and surgical risks using traditional verbal explanations can limit understanding and contribute to dissatisfaction and medicolegal disputes. Augmented reality (AR) may provide patient-specific, interactive 3D visualization to support these conversations. Objective This study evaluates whether AR-assisted preoperative risk communication improves objective understanding and other SDM-related outcomes, compared with communication supported by a conventional physical anatomical model within a standardized SEGUE-informed protocol. Methods A prospective, single-center, randomized controlled trial was conducted with 62 neurosurgery communication recipients (patients when capable; otherwise, a legally authorized representative LAR). Patients were stratified by planned surgical approach (frontal, parietal, and occipital) and, within each stratum, were randomized into an experimental AR group and a control physical-model group. The primary outcome was postsession objective understanding, assessed by a multiple-choice knowledge questionnaire. Secondary outcomes were subjective understanding, communication satisfaction, pre-to-post anxiety changes, communication duration, and neurosurgeons’ communication skills from video recordings. Results Of the 67 individuals screened, 62 communication recipients were enrolled and completed all assessments (patients, n=30; LARs, n=32; AR, n=32; and control, n=30). Objective understanding was higher with AR than with the physical model in the prespecified pooled comparison (P=.01). Communication satisfaction was also higher with AR (P<.001). There were no clear between-group differences in subjective understanding (P=.41), anxiety changes (ΔState-Trait Anxiety Inventory ΔSTAI Y-1, P=.37; ΔSTAI Y-2, P=.84), in-session face-to-face communication duration (excluding any presession AR technical preparation time; P=.73), or SEGUE scores (P=.60). Exploratory stratified analyses suggested larger comprehension gains with AR in the parietal and occipital approach strata. Conclusions In a standardized preoperative SDM conversation, an integrated visualization-support package combining AR, patient-specific modeling, and interactivity improved neurosurgical decision makers’ objective understanding and satisfaction without prolonging in-session, face-to-face communication duration. Larger multicenter trials with longer-term outcomes are warranted to confirm effectiveness and to evaluate implementation and cost considerations. Trial Registration ISRCTN Registry ISRCTN11483487; http://www.isrctn.com/ISRCTN11483487

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