The Apple Vision Pro, a mixed reality headset, is introduced as a potential tool for neurosurgical planning. This case report describes its first clinical use in the operating room for a ventriculoperitoneal (VP) shunt placement. A 44-year-old female with a history of ruptured intracranial aneurysm presented with worsening confusion and intermittent headache. CT imaging revealed hydrocephalus due to a malfunctioning VP shunt. The Apple Vision Pro was used to visualize and interact with a 3D model of the patient's anatomy, aiding in the planning of the procedure. The 3D model was viewed through the headset, allowing the surgeon to assess the anatomy from different perspectives. A survey of clinicians who used the technology found that the 3D models felt realistic (4.5/5), the display of the real-world view felt natural (4.3/5), and the headset did not cause eye strain or fatigue (4.5/5). Most users indicated they would continue using the headset for future cases (4/5). The Apple Vision Pro is a next-generation mixed reality device with twelve cameras and various sensors that enable high-resolution scene understanding and eye tracking. It provides a seamless experience of displaying digital information in the real-world view. The system allows for individual manipulation of each anatomic layer, enabling better visualization of the ventricles. The headset's high-quality imaging and realistic textures make it feel as if there is a physical model in the room. Despite the headset's comfort receiving a score of 3.7/5, clinicians reported no cybersickness or eye fatigue. The device's release represents a significant advancement in mixed reality technology for healthcare. While the Apple Vision Pro is still in its early stages, it has the potential to revolutionize neurosurgical procedures by providing unprecedented tools for medical professionals. The report highlights the importance of further research and evaluation of the device's clinical and surgical potential. The Apple Vision Pro is expected to have a major impact on the field of neurosurgery and medicine, offering new possibilities for surgical planning and intraoperative navigation.The Apple Vision Pro, a mixed reality headset, is introduced as a potential tool for neurosurgical planning. This case report describes its first clinical use in the operating room for a ventriculoperitoneal (VP) shunt placement. A 44-year-old female with a history of ruptured intracranial aneurysm presented with worsening confusion and intermittent headache. CT imaging revealed hydrocephalus due to a malfunctioning VP shunt. The Apple Vision Pro was used to visualize and interact with a 3D model of the patient's anatomy, aiding in the planning of the procedure. The 3D model was viewed through the headset, allowing the surgeon to assess the anatomy from different perspectives. A survey of clinicians who used the technology found that the 3D models felt realistic (4.5/5), the display of the real-world view felt natural (4.3/5), and the headset did not cause eye strain or fatigue (4.5/5). Most users indicated they would continue using the headset for future cases (4/5). The Apple Vision Pro is a next-generation mixed reality device with twelve cameras and various sensors that enable high-resolution scene understanding and eye tracking. It provides a seamless experience of displaying digital information in the real-world view. The system allows for individual manipulation of each anatomic layer, enabling better visualization of the ventricles. The headset's high-quality imaging and realistic textures make it feel as if there is a physical model in the room. Despite the headset's comfort receiving a score of 3.7/5, clinicians reported no cybersickness or eye fatigue. The device's release represents a significant advancement in mixed reality technology for healthcare. While the Apple Vision Pro is still in its early stages, it has the potential to revolutionize neurosurgical procedures by providing unprecedented tools for medical professionals. The report highlights the importance of further research and evaluation of the device's clinical and surgical potential. The Apple Vision Pro is expected to have a major impact on the field of neurosurgery and medicine, offering new possibilities for surgical planning and intraoperative navigation.