Endoscopic evacuation of intracerebral hemorrhage using mixed reality navigation: case report

Abstract

An adult patient presented with acute neurological deterioration caused by spontaneous intracerebral hemorrhage in the right cerebral hemisphere. Initial computed tomography demonstrated a hyperdense intraparenchymal lesion hematoma associated with perifocal edema and mass effect. Giventhe lesion’s location and the goal of minimizing surgical trauma, a minimally invasive endoscopic evacuation was planned. To optimize preoperative planning, mixed reality–based holographic navigation was employed. Patient-specific three-dimensional models were generated from CT data using dedicated segmentation software and visualized through a headmounted mixed reality device. This approach enabled accurate assessment of the hematoma’s spatial relationship to cortical and subcortical structures, facilitating precise selection of the craniotomy site and surgical trajectory. Endoscopic evacuation was performed via a tubular retractor using 0° and 30° endoscopes, achieving effective hematoma removal without intraoperative complications. Postoperative imaging confirmed satisfactory evacuation with regression of mass effect and no evidence of rebleeding. This case illustrates the potential value of mixed reality–assisted planning as a complementary tool for minimally invasive surgery in intracerebral hemorrhage, enhancing spatial understanding, reducing cognitive load, and supporting safe and targeted surgical strategies