Augmented reality in pediatric craniofacial surgery: clinical experience

Augmented reality (AR) has recently gained a reputation in surgical applications, providing real-time integration of virtual information into the surgeon's field of view. The aim of this paper was to describe the authors' clinical experience with AR using the Microsoft HoloLens 2 head-mounted display (HMD) in pediatric craniofacial surgery, particularly for correcting single-suture craniosynostosis. In this study, the authors compared AR-guided osteotomies with those guided by a traditional neurosurgical navigation system in a cohort of 10 consecutive pediatric patients. Osteotomy lines drawn under both AR and standard neurosurgical navigator guidance were measured using computer-aided design/computer-aided manufacturing templates. Accuracy was evaluated at the ± 1.5-mm and ± 1.0-mm thresholds. The findings demonstrated a statistically significant superior accuracy using AR guidance at the ± 1.0-mm level, achieving an average accuracy of 34% compared to 16% with standard navigation (p = 0.044). The results indicate that AR performs similarly to traditional navigation methods in terms of accuracy. These findings suggest that AR-based HMDs hold significant potential to be a reliable method of intraoperative navigation. Further studies are recommended to implement the application of this technology and assess long-term outcomes.