Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use.

Vitamin D plays a crucial role in bone health by aiding calcium absorption. While prior studies have explored the relationship between vitamin D and fracture prevention in adults, its impact on pediatric fracture healing remains underexplored. This study investigates whether low vitamin D levels correlate with longer healing time in pediatric fractures. A retrospective review of patients (ages: 0-17 years) with extremity fractures and vitamin D levels within a year of injury was conducted at a single institution in the southeastern United States from January 2015 to May 2022. Data were collected on demographics, medical history, injury specifics, treatment, outcomes, and vitamin D levels and supplementation. Serum vitamin D levels greater than 30.0 ng/mL were defined as “normal” and levels at or below 29.9 ng/mL were defined as “low”. Among 166 patients with 186 fractures, normal vitamin D levels were observed in 38.6% of patients and low vitamin D in 61.4% of patients. Patients with low vitamin D levels had longer clinical (P = .019) and radiographic (P = .001) healing times than those with normal levels. Patients with lower extremity fractures and low vitamin D had longer clinical (P = .025) and radiographic healing times (P = .006). Similarly, within those who required operative management, low vitamin D patients had significantly longer clinical (P = .031) and radiographic (P = .043) healing times. Our study demonstrates that low vitamin D levels are associated with prolonged clinical and radiographic healing in pediatric patients with fractures, particularly in those with lower extremity fractures and those requiring surgery. Pediatric orthopaedic surgeons should consider evaluation of vitamin D levels in these patients, as healing may be prolonged in patients with low vitamin D levels. (1) Pediatric patients with low vitamin D levels had longer time to clinical return to activity. (2) Pediatric patients with low vitamin D levels had longer time to radiographic healing. (3) Clinicians should be suspicious of low vitamin D in a pediatric fracture patient with prolonged healing. Level III, Cohort Study