• Fatih Incekara, Marion Smits, Clemens Dirven, and Arnaud Vincent.
• Department of Neurosurgery, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, Zuid-Holland, The Netherlands. Electronic address: f.incekara@erasmusmc.nl.
• World Neurosurg. 2018 Oct 1; 118: e422-e427.

ObjectiveNeuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a proof of concept by testing the clinical feasibility and accuracy of a wearable mixed-reality device (Hololens) for preoperative neurosurgical planning.MethodsIn patients with an indication for brain tumor surgery, preoperative planning of tumor localization with the Hololens was compared with standard neuronavigation in the operating room. Magnetic resonance imaging-based 3-dimensional holograms of the patient's head and tumor were created and projected on the physical patient's head using the Hololens. The 2-dimensional projection of the tumor borders as perceived by the neurosurgeon on the skin of the patient's head was outlined both with the Hololens and neuronavigation. Accuracy of the Hololens localization was assessed using neuronavigation as the gold standard.ResultsTwenty-five patients were included in this study. Holograms were successfully created in all cases. In 9 patients tumor localization with the Hololens did not differ from the standard neuronavigation system and the overall median difference was 0.4 cm (interquartile range 0-0.8).ConclusionsThis prospective clinical study offers a proof of concept of the clinical feasibility of the Hololens for brain tumor surgery planning in the operating room, with quantitative outcome measures. Further development is needed to improve the accuracy of this wearable mixed-reality device.Copyright © 2018 Elsevier Inc. All rights reserved.

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