Anatomical localization and resection of a refractory epileptic focus in the right supplementary motor area/presupplementary motor area using augmented reality: illustrative case

AR has multiple applications in neurosurgery, including preoperative planning, anatomical verification, and intraoperative guidance. In this case, AR navigation provided real-time 3D overlays of MRI- and CT-derived patient anatomy onto the surgical field, allowing visualization of segmented cortical surface anatomy, vascular structures, white matter tracts, and electrodes via voice commands. This enabled precise mapping of deep-seated anatomy and electrode trajectories without increasing operative time or complication risk. Given the early stage of the technology, AR was used adjunctively with neuronavigation during SMA/pre-SMA resection and demonstrated localization concordant with traditional mapping techniques. https://thejns.org/doi/10.3171/CASE25611.