PURPOSE: Immersive spatial computing technologies, including virtual reality (VR), augmented reality (AR), and mixed reality (MR), are increasingly applied across the neurosurgical pathway. This paper explores their evolution and modern role in cranial and spinal neurosurgery. MATERIALS AND METHODS: A narrative review of the contemporary neurosurgical literature was undertaken, compiling evidence relating to VR, AR, and MR, including their integration with neuronavigation. Applications across training, planning, guidance, and recovery were considered. Emphasis was placed on underlying technical principles, evidence quality, and implementation barriers. RESULTS: VR is most established for training and preoperative planning, with evidence supporting improved understanding and early data suggesting skill transfer in selected contexts. AR and MR systems enable spatially aligned intraoperative visualisation and have demonstrated feasibility and accuracy, particularly in spinal instrumentation. Across modalities, evidence largely supports technical feasibility rather than definitive improvements in patient-level outcomes. Key limitations include heterogeneous designs, cultural barriers to adoption, and workflow challenges. CONCLUSIONS: Immersive spatial computing technologies are transitioning from adjunctive tools towards integrated components of a broader surgical-computer ecosystem. Their future impact in neurosurgery will depend on effective integration with neuronavigation, robotics, and artificial intelligence, as well as cultural readiness and continued improvement in workflow compatibility.
Bolton et al. (Tue,) studied this question.