2026 Poster Presentations
P319: MULTIPLE APPLICATIONS FOR HEADS-UP DISPLAY GUIDED NEUROLOGICAL SURGERY USING THE LEICA MYVEO SYSTEM: A DESCRIPTIVE CASE SERIES
Henry A Freeman, BS1; Kamal Shaik, BS2; Michael Karsy, MD, PhD3; 1Michigan State University; 2Drexel University College of Medicine; 3Department of Neurosurgery, University of Michigan, Ann Arbor, MI
Background/Introduction: Heads-up display (HUD) systems and augmented reality (AR) platforms are transforming neurosurgical visualization by integrating neuronavigation, fluorescence imaging, and multimodal data overlays directly into the surgeon’s field of view. These technologies aim to enhance precision, ergonomics, and intraoperative efficiency, particularly in minimally invasive and complex cranial procedures, providing 4K stereoscopic visualization, neuronavigation overlay, and amplified Blue-400, FL560, and FL800 fluorescence. While exoscope and simulation-based studies suggest ergonomic and workflow benefits, real-world clinical evidence remains limited across diverse neurosurgical domains.
Objective: To describe early clinical applications of the Leica MyVeo HUD system in cranial neurosurgery, evaluating feasibility, safety, ergonomic impact, and integration of multimodal imaging.
Methods: We conducted a multi-surgeon, single-institution retrospective case series of patients undergoing cranial procedures with the MyVeo HUD between January and September 2025. Over 130 consecutive cases were performed, including glioma resection with 5-ALA guidance, vestibular schwannoma resection, trigeminal neuralgia microvascular decompression, and skull base tumor surgery. Additional spine cases performed during the study period were reviewed. Patient demographics, surgical outcomes, and intraoperative measures, including surgeon feedback regarding ergonomics, workflow integration, and visualization quality, were also documented.
Results: Intraoperatively, the HUD enabled real-time neuronavigation overlay, fluorescence-guided tumor delineation, and improved orientation of critical neurovascular structures. Surgeons reported enhanced posture and reduced fatigue during lengthy cranial and skull base procedures. Surgical operation times were measured based on procedure type and compared to the standard procedure operating time for the equivalent procedure. Of the 130+ cases, only one required conversion to conventional microscopy due to limited resolution. No intraoperative complications were attributable to HUD use.
Conclusion: This initial clinical experience supports the feasibility and safety of HUD-guided cranial neurosurgery, including skull base and minimally invasive procedures. Advantages included improved ergonomics, seamless integration of multimodal imaging, and precise anatomical localization. Limitations included a learning curve and occasional challenges with visualization at high magnification. These findings extend prior simulation and exoscopic literature by demonstrating practical, real-world applications of HUD systems in cranial surgery. Future prospective and comparative studies are warranted to define operative efficiency, learning curve dynamics, long-term outcomes, and cost-effectiveness of HUD-assisted neurosurgery. As hardware and software continue to evolve, HUD-assisted neurosurgery may increasingly contribute to ergonomic stability, intraoperative decision-making, and decreased operating times.