Brain tumors are the leading cause of death in children. The majority of children diagnosed with a brain tumor undergo surgery. Although radiology assessment tools allow for swift detection of brain tumors, preoperative planning is difficult on traditional monitors as radiologists and surgeons must visualize 3D structures in relationship to the brain tumor from 2D imaging in CT and MRI. Therefore, changes must be made to the traditional radiology workstation to allow for more detailed preoperative planning to improve patient outcomes and decrease complications during surgery. The Apple Vision Pro (AVP) device is a mixed reality headset that, when paired with Visage Ease VP (VEVP), an image viewing application built for the AVP, offers a 3D model display and traditional 2D image viewer.

This was a retrospective study of preoperative and postoperative evaluations in pediatric posterior fossa brain tumors (n = 5, tumor types = diffuse midline glioma, ependymoma, atypical teratoid rhabdoid tumor, and medulloblastoma). The advantages identified include the large virtual screen, reducing eye strain when looking at small lesions; intuitive, easy to learn hand gesturing for tool control; and improved perspective of surrounding anatomy adjacent to the tumor. Many of the disadvantages identified were software glitches and hardware, rather than difficulties with the images or models themselves. The disadvantages included uploading errors which resulted in missing images and only partial 3D models displayed; unlabeled buttons of VEVP which made the software difficult to learn; the AVP crashing while running VEVP during Apple’s screen mirroring function; and an inability to wear glasses with AVP. The most significant conclusion from the retrospective evaluations was that VEVP on AVP offered better visualization of the brain tumors to adjacent structures which provided a more in-depth comparison while manipulating the 3D models. The evaluating radiologist recommends AVP for further investigation and recognizes the device as an effective, low-cost alternative to 3D printing for use in preoperative planning. A future collaboration with neurosurgeons will apply the results to validate better surgical and clinical outcomes for patients while researching intraoperative use of the AVP.