Holographic-Assisted Neurovascular Surgery: Mixed-Reality Innovations for Precision in Aneurysms and AVMs

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Abstract
Mixed-reality technologies, including augmented reality, virtual reality, and holographic visualization, have emerged as transformative tools in neurovascular surgery. Their integration into the management of intracranial aneurysms and arteriovenous malformations provides enhanced three-dimensional understanding, improved intraoperative orientation, and advanced simulation-based training opportunities. This review synthesizes evidence from 20 peer-reviewed studies originating from North America, Europe, Asia, and Latin America, including contributions from Mexico, Colombia, and Ecuador. The findings demonstrate that mixed reality significantly strengthens preoperative planning by enabling volumetric exploration of vascular structures and improves intraoperative decision-making through dynamic overlays and fluorescence-integrated navigation. Virtual reality platforms further expand their role by offering high-fidelity rehearsal of microsurgical techniques, contributing to more consistent skill acquisition. Despite these advantages, limitations remain regarding registration accuracy, display stability, and accessibility in resource-limited settings. Nevertheless, the overall balance of evidence suggests that mixed reality is reshaping neurovascular workflows and will likely become a foundational component of future cerebrovascular care. Continued innovation, multicenter validation, and broader integration across diverse healthcare environments will be essential to fully realize its clinical and educational potential.

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