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Conventional image guidance systems have become the standard for planning in neurosurgical procedures. While these systems have been shown to increase accuracy and precision for a variety of cases, there are still drawbacks. Such limitations revolve around the use of multiple physical components to separately display the information and the substantial amount of training time required for residents to become familiar with these systems. These disadvantages can increase the difficulty of the surgery unnecessarily, and thus affect quality. To address these concerns, a mixed reality application was developed on the Microsoft HoloLens as a surgical planning and teaching tool. Neurosurgeons could see head, brain, and tumor holograms and create a craniotomy plan through hologram interaction. These interactions included the ability to rotate the head to its desired location, perform an image-to-physical registration, and utilize a virtual stylus to collect points for the surgical plan. Furthermore, the app was expanded to also track physical tools with an optical tracker to provide a more realistic surgical planning scenario. With a tracked stylus, the user was capable of selecting points on the physical head to perform a registration where the 3D neuroanatomy models properly appeared in the physical head as a virtually augmented structure. To evaluate the prototype, practicing neurosurgeons were provided a demonstration and then promptly interviewed to assess design and efficacy. The tool alignment procedure was also evaluated to quantify the calibration error. Initial responses indicated that the prototype could be an effective surgical teaching and planning tool for less-experienced neurosurgeons because it could allow neurosurgeons to view physical and image space simultaneously.
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