Introduction: Augmented reality (AR) is a set of different technologies, all aiming to project virtual content into the real environment, compared to virtual reality, where the user is immersed in a computer generated world. Neurosurgery has always been at the forefront of this technology, and gives the greatest contribution to the literature. During the past two decades neuronavigation has been an essential tool trying to achieve maximal safety and minimal invasiveness.

Aims: In our examination we aim to overview the present state of art usage of AR in neurosurgery and demonstrate our initial experience of AR assisted transsphenoidal pituitary tumor resections.

Methods: We surveyed the Pubmed database for systematic reviews of AR assisted neurosurgery and tried to adapt the results in our transsphenoidal operations using the Medtronic Stealth Station8 neuronavigation system.

Results: Conventional navigation and imaging technologies have tremendously advanced neurosurgery, however the ergonomics of the devices are not optimal. The neurosurgeon has to look away from the surgical field to a dedicated workstation screen, then transfer the 2D information back to the operative situation. The injection of multimodal images (MRI, CT, angiography or tractography) can reduce operation time, the frequency of revisions and the radiation exposure (particularly in spine surgery screw insertion). AR has brought major advances in education and precision of tumor resections. In our few cases AR helped in the identification the main landmarks of the sellar region, the internal carotid arteries, the optic nerves and the pituitary gland itself.

Conclusion: The use of AR is significantly increased in the past decades. Nowadays it is mainly used in spine surgery and education. AR assisted neuronavigation using the real data source of microscope or endoscope can improve outcomes in transsphenoidal surgery in landmark identification especially in patients with anatomical variations.