Table 1.

Summary of included studies

Study	Digital tool evaluated	Area of application	Outcome	Limitations
Alaraj et al, 2015⁵	Simulation/digital models	Education and preoperative planning	3D anatomical details closely resembled real operative anatomy and were useful in guiding surgical approaches	Few found the haptic feedback to closely resemble surgical procedures
Alsofy et al, 2020⁶	Simulation/digital models	Pre-operative planning	Improved detection of aneurysm-related vascular structures and appropriate surgical approaches	May tempt surgeons to neglect a wider array of approaches
Ashkenazi et al, 2015⁷	Telemedicine	Pre-operative planning	Reduced number of institutional transfers	None described
Bairamian et al, 2019⁸	Simulation/digital models	Education	VR angiography improved resolution, ease of manipulation, model durability and educational potential	Poorer depth perception
Breimer et al, 2017⁹	Simulation/digital models	Education	Relative VR benefits with respect to realistic representation of intraventricular anatomy	Reduced overall instrument handling and procedural content
de Almeida et al, 2020¹⁰	Smartphone applications	Perioperative	High accuracy and reliability of stereotactic brain biopsy coordinates	Certain features of interest are not available
de Notaris et al, 2011¹¹	Simulation/digital models	Pre-operative planning	Improved quantification of intraoperative bone removal	Time consuming, not available intraoperatively, lack of depth perception
de Notaris et al, 2010¹²	Simulation/digital models	Pre-operative planning	Improved quantification of intraoperative bone removal	Time consuming, not available intraoperatively, lack of depth perception
Dong et al, 2018¹³	Simulation/digital models	Education	High reported fidelity, high user satisfaction and perceived usefulness	None described
Fan et al, 2020¹⁴	Robotics	Perioperative	Significantly improved screw-placement accuracy, reduced operative blood loss and length of stay	Learning curve required, unclear infection control protocol
Hou et al, 2016¹⁵	Smartphone applications and simulation/digital models	Pre-operative planning	High accuracy in predicting basal ganglia haematoma location	No error checking or location information during surgery
Latifi et al, 2018¹⁶	Telemedicine	Pre-operative planning	Decreased need for institutional transfer	Challenges with initial cost, integration
Li et al, 2017¹⁷	Remote programming	Postoperative care	Significant decreases seen in UPDRS scores	None described
Ma et al, 2021¹⁸	Remote programming	Postoperative care	Rapid symptom relief, institutional cost savings	Lack of physical examination data
Macyszyn et al, 2013¹⁹	Telemedicine	Electronic patient records and interdepartmental communication	Cost savings through elimination of repeat imaging requests	Increased operational complexity for departmental staff
Mandel et al, 2018²⁰	Smartphone applications	Perioperative	Enhanced surgical mobility	None described
Mendez et al, 2013²¹	Remote programming	Postoperative care	High levels of patient and clinician satisfaction	No benefit in accuracy of programming or rate of adverse events
Moya et al, 2010²²	Telemedicine	Pre-operative planning	Decrease in patient transfer requests	None described
Olldashi et al, 2019²³	Telemedicine	Pre-operative planning	Improved access to care, decreased institutional transfer for low-risk patients	Initial set-up costs
Shibata, 2011²⁴	Telemedicine	Pre-operative diagnosis/planning	Earlier diagnosis of cerebral contusions, earlier escalation; improved planning time prior to emergency surgical intervention	Increased workload for consultant neurosurgeons
Stepan et al, 2017²⁵	Simulation/digital models	Education	Increased engagement, motivation and satisfaction compared with conventional teaching	No improvement in clinical knowledge scores
Thapa et al, 2016²⁶	Smartphone applications	Pre-/postoperative care, interdepartmental communication and education	Reduced time taken to interpret clinical images, improved intra-team and interdisciplinary communication	Significant discrepancies in image interpretation, greater risk of misuse of patient data
Wong et al, 2007²⁷	Simulation/digital models	Education/pre-operative planning	Users gained a better understanding of the best approach for microsurgical clipping for the patient	None described
Xu et al, 2020²⁸	Remote programming	Postoperative care	Significant improvement in UPDRS-III; 89.29% of patients were satisfied or very satisfied	Reduced opportunity for physician-led physical examination to assess changes in muscle tone
Zappa et al, 2019²⁹	Robotics	Perioperative	Improved completion times in bimanual tasks, decreased surgical fatigue	Results indicated more difficulty and higher fatigue in simple grasping tasks
Zhang et al, 2019³⁰	Robotics	Perioperative	Increased accuracy of screw placement, decreased radiation doses, reduced rate of screw revisions	Greater learning curve, not necessarily more effective in completion of simple tasks, variable mental fatigue scores

UPDRS = Unified Parkinson's Disease Rating Scale; VR = virtual reality.