Mixed reality holographic navigation for intracranial lesions using HoloLens 2: A pilot study and literature review

Abstract

Objective

This study aims to evaluate the feasibility and efficacy of HoloLens 2-based mixed reality (XR) holographic navigation for intracranial lesions in neurosurgery, comparing its performance with the conventional navigation system. Materials and

Methods

A pilot study was conducted involving 20 patients with various intracranial lesions between March 2023 and May2025. Magnetic resonance imaging with/without computed tomography angiography imaging data were acquired for both the conventional navigation system and the HoloLens 2 platform. As for the XR technology, the process involved uploading imaging data to a cloud platform for three-dimensional reconstruction, followed by the creation of the holographic model. During surgery, the holographic model was downloaded onto the HoloLens 2, and a point-based registration method was employed to align the holographic model with the patient's anatomy. The localization accuracy and registration working times were compared between the two systems.

Results

The cohort included 20 participants (11 males, 9 females; mean age 47.8 ± 15.3 years) with diagnoses such as meningioma (10 cases), vascular lesions (5 cases), glioma (3 cases), and lymphoma (2 case). Both senior neurosurgeons agreed on the accuracy of HoloLens 2's holographic projections, which were comparable to conventional navigation. The average registration working time for the HoloLens 2 was 5.7 ± 2.0 min, significantly faster than the conventional navigation system (9.3 ± 2.9 min) (P < 0.001). Additionally, HoloLens 2 demonstrated shorter registration working times across different head positions.

Conclusion

Preliminary findings suggest that HoloLens 2 can serve as a portable and efficient navigation tool in neurosurgery, offering comparable localization accuracy to the conventional navigation system while significantly reducing registration working time. This technology has the potential to enhance surgical procedures and improve healthcare delivery in grassroots settings, making advanced neurosurgical navigation more accessible. Further research with larger cohorts is expected to substantiate these concepts.