Authors: Ye Li, MD, PhD; Ning Wang; Wenyao Zhang; Xiaolei Chen (Beijing, China)

Introduction: Freehand transcranial puncture and drainage based on anatomical surface landmarks is one of the common operations for the treatment of spontaneous intracerebral hemorrhage (SICH). However, it often faces the problem that the target is deep and the catheter positioning is experience-dependent. The goal of this study was to explore the accuracy of using a wearable mixed-reality holographic computer to guide transcranial puncture for the treatment of SICH. Methods: 41 SICH patients who needed transcranial puncture were enrolled into this prospective, randomized, single-center study. 20 patients were randomized into the hologram-guided transcranial puncture group (group A), and 21 into the freehand group (group B). Pre- and postoperative CT scanning were performed routinely for every patient. Surgical plan including model reconstruction and trajectory calculation for group A was completed based on preoperative CT. By wearing a Microsoft HoloLens, the neurosurgeon was able to visualize the surgical plan and perform transcranial puncture by keeping aligned with the holographic trajectory. The accuracy of the hologram-guided technique were evaluated by comparing the operation time, number of passes, and target deviation between the 2 groups. Results: Hologram visualization were achieved in all the cases of group A. The mean operation time of group A was 37.44 ± 12.53 mins, compared with 54.38 ± 15.35 mins in group B (p < 0.01). The average number of passes was 1.12 ± 0.47 in group A, compared with 2.52 ± 0.66 in group B (p < 0.01). The mean target deviation was 5.47 ± 2.08 mm in group A and 13.14 ± 0.38 mm in group B (p < 0.01). Conclusion: This study demonstrates the use of a wearable mixed-reality holographic computer to successfully perform hologram-guided transcranial puncture for the treatment of SICH. The authors also provide preliminary confirmation of the accuracy of this hologram-guided technique.