To the Editor: We read with great interest the recent article titled "Navigated Intraoperative Ultrasound Offers Effective and Efficient Real-Time Analysis of Intracranial Tumor Resection and Brain Shift" published by West et al. This study addresses a promising subject in neurosurgery, specifically the use of navigated intraoperative ultrasound (iUS) to enhance the accuracy and efficiency of brain tumor resection. The study findings underscore the significant potential of iUS to provide real-time imaging and improve surgical outcomes by addressing brain shift during surgery.1 Building upon these advancements, there has been growing interest in further developing real-time imaging tools through the integration of augmented reality (AR) technology. AR superimposes computer-generated images onto the user's view of the physical world, creating a blended image that enhances their current perception of reality.2 It might have the potential to revolutionize intraoperative visualization and precision, providing surgeons with improved tools to accurately navigate complex anatomic structures and make more informed decisions during surgery. Neuronavigation and microscope-based AR are extensively used in neurosurgery to aid intraoperative orientation, protect neurological function, and maximize the extent of tumor resection.3 In recent years, AR has shown rapid advancement, delivering unprecedented precision in the surgical treatment of central nervous system tumors.4 AR devices allow surgeons to visualize patient anatomy by integrating 3-dimensional (3D) reconstructed computed tomography or MRI scans directly into the surgical field, known as "in situ" visualization.2 Integrating navigated iUS with AR systems could therefore provide surgeons with real-time 3D visualization of the tumor and surrounding structures, improving spatial orientation and resection accuracy. This integration could build upon the existing benefits of neuronavigation-guided iUS, taking surgical precision and efficiency to new heights. Recent studies have demonstrated that AR in combination with iUS may enhance surgical precision and reduce the amount of healthy tissue excised in complex procedures by providing a clear view of relevant anatomic landmarks and structures throughout an extended duration of the procedure.5 The combination of both technologies has improved surgical accuracy by addressing issues related to misregistration, brain displacement, and AR limitations.6 Furthermore, integrating ultrasound-based registration with AR has enhanced patient-specific intraoperative planning, improving the comprehension of complex 3D medical imaging data and extending the reliable use of image-guided neurosurgery.6 By overlaying 3D iUS images through AR, a 3D representation of the tumor and adjacent structures is created enhancing spatial orientation, aiding surgeons in more precise neuronavigation during tumor resection. This may improve accuracy for localizing tumor margins and critical anatomic structures improving the extent of resection while minimizing risk of injury.5 Furthermore, the combination of AR technology and ultrasonography could be highly beneficial in teaching settings to improve skills and reduce the learning curve for residents and neurosurgeons being introduced to these technologies. Access to the same visual overlays as those seen during real-time surgery could be a valuable tool in training. Incorporating iUS with AR in neurosurgery could also be beneficial in low- and middle-income countries. Given the limited access to advanced medical equipment and highly specialized surgical training in these regions, iUS and AR can potentially offer cost-effective alternatives in both outside operating room training and during practice, with enhanced surgical precision and safety.2 By reducing the need for more expensive imaging modalities and making training accessible for surgeons, this integration could help bridge the gap in healthcare quality, making cutting-edge neurosurgical techniques more accessible and affordable. Among the limitations for neuronavigation and AR systems is the inability to adjust for intraoperative brain tissue shift caused by changes in positioning or cerebrospinal fluid leakage, which leads to increased alignment errors in AR.7 To maintain precise navigation and AR support, it is essential to frequently verify and update the navigation system, and therefore, implementing iUS could serve as a user-friendly tool to confirm accuracy and generate real-time image data to update navigation without significantly disrupting the surgical workflow; the use of iUS could address one of the main limitations of this technology.8 The study provided by West et al highlights the benefits of iUS in enhancing surgical precision and addressing brain shift. We believe that the use of this technology along with other upcoming tools such as AR can open new avenues for continuous improvement in surgical outcomes and enhanced learning surgical tools. AR could potentially build upon the real-time visualization capabilities of iUS in training and during practice. Further future research could explore practical implementation challenges, cost-effectiveness, and long-term patient outcomes associated with AR-iUS integration, paving the way for its widespread adoption in neurosurgery. We greatly congratulate West and his team for their work and continuous effort in expanding the knowledge in this growing field.