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

• Published in: Clinical neurology and neurosurgery Vol. 256; p. 109030
• Main Authors: Yang, Zixiao, Su, Xingfen, Yuan, Zhiyi, Yuan, Yifan, Liu, Jian, Wang, Zhicheng, Jin, Ke, Ye, Ningrong, Zhang, Jiakang, Cai, Jiajun, Huang, Qiu, Song, Jianping
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2025; Elsevier Limited
• Subjects: Accuracy; Adult; Aged; Angiography; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Brain research; Case series; Cloud computing; Computed tomography; Feasibility Studies; Female; Health facilities; Holographic Medicine; Holography - instrumentation; Holography - methods; HoloLens 2; Hospitals; Humans; Imaging, Three-Dimensional - methods; Intraoperative Navigation; Lesions; Literature reviews; Localization; Lymphoma; Magnetic Resonance Imaging; Male; Meningioma; Meningioma - diagnostic imaging; Meningioma - surgery; Middle Aged; Mixed Reality; Navigation systems; Neurology; Neuronavigation - instrumentation; Neuronavigation - methods; Neurosurgery; Neurosurgical Procedures - methods; Patients; Pilot Projects; Planning; Registration; Statistical analysis; Surgeons; Working hours; United States > US; Intraoperative Navigation; HoloLens 2; Case series; Holographic Medicine; Mixed Reality
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2025.109030

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 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. 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. 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. •The mixed reality (XR) navigation offers intuitive 3D holographic projections, enhancing surgeons' spatial understanding of anatomy.•Through effective algorithm design and workflow optimization, the Hololens 2 can function as a stand-alone portable XR navigation device.•The pilot study indicates that HoloLens 2 can achieve localization accuracy comparable to conventional navigation systems.•This study also demonstrated that HoloLens 2 may offer shorter registration working times than the conventional navigation system.•HoloLens 2 may serve as a cost-effective, portable navigation solution, making navigation technology more accessible in grassroots hospitals.