Mixed reality with 3D brain imaging for patient consultation in neurosurgery: an IDEAL stage 2a feasibility study

Abstract

Background: This study aimed to investigate the feasibility of introducing additional Mixed Reality (MR) visualisation of patient-specific imaging during the neurosurgical consultation to improve patients’ understanding, as well as the potential benefits from a patient’s perspective to the consultation process. Methods: An IDEAL Stage 2a feasibility randomised controlled trial was conducted involving patients with radiologically suspected brain tumours at a large, tertiary UK neurosurgery institution. Patients were randomised into two groups: standard 2D monitor versus additional MR visualisation. Primary feasibility outcomes included recruitment rates, MR intervention adherence, fidelity, and acceptability. Secondary outcomes included patient-reported experiences. Quantitative and qualitative analyses were performed via validated questionnaires. Results: A total of 36 patients were randomised over 12 months, 17 to a Mixed Reality (MR) Group and 19 to a standard 2D monitor-only group, with no significant baseline differences. MR intervention was deemed feasible for further clinical evaluation with high fidelity and user acceptability. Patients in the MR group reported statistically higher satisfaction with information received, an improved patient-doctor relationship, greater confidence in decision-making, and a better understanding of their condition compared to the standard 2D monitor-only group. No major technological issues were encountered. No adverse effects were reported or observed (including cybersickness). Patients found the MR technology easy to use. Conclusions: Our findings suggest that incorporating MR visualisation into routine neurosurgical consultations is feasible and offers potential benefits for patients. With minor modifications to the intervention and assessments, we aim to perform a larger-scale, multi-centre randomised feasibility trial, which will also address implementation challenges for widespread adoption and provide more indication of efficacy.