Abstract： Objective:To investigate the application value of mixed reality technology in surgical resection for vestibular schwannomas (VS).Methods:The clinical data of 25 patients with VS who underwent neurosurgery at the Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2021 to February 2022 were retrospectively analyzed. All patients underwent preoperative temporal bone CT, fast imaging employing steady-state acquisition with cycled phases, and diffusion tensor imaging. The 3D model was established using 3D-Slicer software, and the 3D model image was presented by mixed reality technology to predict the positional relationship between the tumor and the facial and auditory nerves, so as to develop an individualized surgical plan. Taking the results of intraoperative neurophysiological monitoring as the gold standard, the Kappa test was used to evaluate the consistency between the course of the preoperatively reconstructed facial nerve and the positioning of intraoperative neurophysiological monitoring. All 25 patients underwent surgery through the retrosigmoid approach. The facial nerve function of the patients was evaluated by House-Brackmann classification before operation and 1 week after operation.Results:All 25 patients successfully underwent reconstruction of the three-dimensional model of VS before operation, and the median volume of the tumor after reconstruction was 6.18 cm 3 (0.73-16.86 cm 3). Among them, facial nerve reconstruction was successful in 23 cases (92.0%), and reconstruction failed in 2 cases. The satisfaction rate of keyhole positioning during craniotomy was 96.0% (24/25), and there were no patients with venous sinus injury. Among the 23 patients who successfully underwent reconstruction of the facial nerve before operation, 20 cases showed completely consistency between reconstruction results and the facial nerve positioning based on the intraoperative neurophysiological monitoring, and the accuracy rate was 86.9%. The Kappa test showed that there was a strong consistency between the course of the preoperatively reconstructed facial nerve and the positioning of facial nerve based on intraoperative neuroelectrophysiological monitoring (Kappa=0.836, P<0.01). Postoperative re-examination of MRI in 25 patients showed that the tumors were completely resected. One week after operation, the House-Brackmann classification was grade Ⅰ in 6 cases, grade Ⅱ in 9 cases, grade Ⅲ in 6 cases, and grade Ⅳ in 4 cases. There was no case of cerebrospinal fluid leakage. Conclusion:Preoperative reconstruction of the three-dimensional model with mixed reality technology can assist in the surgical resection of VS, which is beneficial to the protection of the facial nerve during the operation and reduction of the surgical side injury.