**8. The future of AI in neurosurgery**

Future directions of AI integration into the field of neurosurgery involve both simple and complex solutions, some with global implications. The rise of telemedicine during the COVID-19 pandemic resulted in expanded applications which can be further built upon to partially address the global shortage of neurosurgeons [165]. Approximately 39 countries do not have access to neurosurgical care [3]. Smartphone apps can be used for postoperative follow up, obviating the need to travel prolonged distances to receive continued evaluation. Telesurgery has garnered significant interest, as the potential to decrease transportation costs, improve logistics, and reduce the carbon footprint associated with medical tourism is great. Conceptualized iterations

involve an operative suite with robotic equipment that will be controlled by surgeons in a control room. Given the paucity of neurosurgeons relative to the population in need globally, it has been proposed that a general surgeon be at the control room adjacent to the patient, while a neurosurgeon is at the helm in a remote control room [165]. This also has implications for military use as surgeons would be able to care for patients in war zones remotely rather than risking their lives in the field [165].

Within the operating room, the push toward improved logistics and ergonomics as well as minimal to no contact procedures continues. Technologies to merge the microscope view, navigation imaging, and virtual or augmented reality screen into a single device such as surgical glasses are being developed [165]. There are a few augmented reality glasses (HoloLens, xvision Spine System) designed for surgical planning that are already commercially available [169]. The glasses project 3-D models of the patient's anatomy (based on preoperative CT scans) directly into the surgical field, and can be controlled in a contactless manner with hand gestures and voice commands [169]. Magnetic navigation systems are being piloted for contactless endovascular operations [3].
