Real-time augmented reality navigation in brain glioma resection: a pilot feasibility study

Objective To evaluate the clinical feasibility and technical performance of augmented reality (AR) navigation for brain glioma resection in a preliminary patient series. Methods From April 2024 to May 2025, 6 patients with brain glioma were enrolled in this pilot study. Preoperative magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and magnetic resonance angiography (MRA) data were processed and imported into an AR head-mounted device. The 3D holographic models were reconstructed to enable preoperative surgical planning, simulation of resection pathways, and intraoperative AR navigation. The primary outcomes included AR registration time, target registration error (TRE) verified by an optical navigation system (StealthStation S7), extent of resection on postoperative MRI, and neurological function assessed by the Modified Rankin Scale (mRS) and detailed neurological examination at 3 months. Results Gross total resection of the contrast-enhancing tumor was achieved in all patients. The mean AR registration time was 4.7 ± 0.7 min. The surface-matching registration yielded a TRE of 2.1 ± 0.4 mm compared to the StealthStation reference. Postoperative mRS scores improved significantly at 3 months (p = 0.03). Conclusion This pilot study demonstrates that AR navigation is technically feasible for brain glioma resection. However, the small sample size limits conclusions about clinical efficacy.