Portable mixed reality navigation system for neurosurgery: a clinical feasibility study

Abstract

This study aimed to develop a portable mixed reality navigation (PMRN) system for neurosurgery and assess its feasibility, providing design insights for the optimization and wider adoption of mixed reality navigation. The PMRN system linked a head-mounted display (HMD) and a portable laptop via a router, forming a local network. Active infrared tracking enabled real-time localization of a custom surgical probe. Accuracy was first tested in a laboratory using simulation models, then evaluated in a prospective clinical study of 42 patients with intracranial lesions. Clinically, the probe of a traditional optical navigation (TON) system was placed at PMRN-localized targets, and the Euclidean distance between the two systems was measured to quantify localization error. Doctors also subjectively assessed the alignment of mixed reality holograms with patient anatomy to evaluate reliability. In laboratory testing, two doctors each performed 10 simulated head model localizations, with an average time of under 5 min. The times decreased with practice and stabilized at approximately 3.5 min. The maximum fiducial registration error (FRE) and target registration error (TRE) were 2.5 mm and 2.3 mm, respectively, with no significant difference between doctors. In the clinical study (n = 42 patients), the mean localization time was 4.3 ± 1.0 min, the FRE was 2.2 ± 0.7 mm, and the TRE was 1.7 ± 0.5 mm. Doctors rated the hologram–patient alignment as satisfactory in 40 cases (95%); the remaining two cases showed a 3 mm deviation, which was attributed to slight patient movement or reduced device performance in low-battery mode. The PMRN system is portable, easy to use, and achieves millimeter-level accuracy in neurosurgical procedures with high surgeon satisfaction. It meets the needs of most routine operations but requires further refinement for submillimeter-precision procedures. These results confirm its clinical feasibility and support its further development and adoption in mixed reality neurosurgical navigation.