Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(01): 069-073
DOI: 10.1055/s-0041-1725233
Original Article

Three-Dimensional Virtual Reality Simulation to Safe Planning Neurosurgical Procedure in Brain Aneurysms, Latin American Single-Center Experience: Advantages and Limitations

Antonio M. Zárate-Méndez
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
,
José M. Ramos-Delgado 
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
,
Juan C. Lujan-Guerra 
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
,
Carlos D. Rio-Olivares
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
,
Luis E. Moreira-Ponce
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
,
José L. Aceves-Chimal
1   Department of Neurosurgery, Centro Médico Nacional “20 de Noviembre” Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background The neurosurgical approach to clipping cerebral aneurysms has been a complex challenge for all neurosurgeon experts in cerebrovascular surgery. The three-dimensional computed tomography angiography (3D-CTA) allows identifying bone and vascular structures close to an aneurysm to simulate in virtual 3D images, the appropriate and safest approach to cerebral aneurysm clipping.

Objectives This study aims to share our experience using 3D simulation as a support to the safe planning for cerebrovascular disease surgery.

Materials and Methods We reviewed the surgical outcomes from a cerebrovascular neurosurgeon using the 3D-CTA images in 360-degree reconstruction in the planning of the preoperative surgical procedure for the treatment of brain aneurysm. In all patients, the virtual surgical approach was replicated in real-time surgery.

Results We analyzed 34 patients around 51 ± 8 years of age. Of these, 76.5% (n = 26) and 23.5% (n = 8) were males and females, respectively. Saccular aneurysms were the most frequent (85%), the Arteries affected by aneurysms were middle cerebral artery (n = 6), basilar tip (n = 6), vertebral artery in V3 and V4 (n = 6), and posterior cerebral artery (n = 5). The virtual surgical pterional approach was the most frequently used (50%), followed by fronto-orbito-zigomático (29%) and far lateral (15%) approaches. There were no intraoperative complications in any patient.

Conclusion Preoperative 3D virtual reality simulation is a great support tool to perform a safe surgical procedure in real-time for the treatment of simple and complex brain aneurysms.

Keywords

cerebral aneurysm - virtual preoperative surgical approach - 3D-CTA - approach simulation - safe planning surgery


Publication History

Article published online:
15 March 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Amacher AL, Drake CG. Aneurysm surgery in the seventh decade. In: Fusek I, Kunc Z, eds. Present Limits of Neurosurgery—Proceedings of the Fourth European Congress of Neurosurgery. June 28–July 2, 1971, in Prague. Prague: Czechoslovak Medical Press 1972
  • 2 Chan S, Conti F, Salisbury K, Blevins NH. Virtual reality simulation in neurosurgery: technologies and evolution. 2013; 72 (Suppl. 01) 154-164
    PubMedGoogle Scholar
  • 3 Harbaugh RE, Schlusselberg DS, Jeffery R. et al. Three-dimensional computed tomographic angiography in the preoperative evaluation of cerebrovascular lesions. Neurosurgery 1995; 36 (02) 320-326 discussion 326–327
    CrossrefPubMedGoogle Scholar
  • 4 Bull JWB. Contribution of radiology to the study of intracranial aneurysms. BMJ 1962; 2 (5321) 1701-1708
    CrossrefPubMedGoogle Scholar
  • 5 Matsumoto M. Three dimensional computerized tomography-angiography guide surgery of acutely ruptured cerebral aneurysm. J Neurosurg 2001; 94 (05) 718-727
    CrossrefPubMedGoogle Scholar
  • 6 Nagai M, Watanabe E. Benefits of clipping surgery based on three-dimensional computed tomography angiography. Neurol Med Chir (Tokyo) 2010; 50 (08) 630-637
    CrossrefPubMedGoogle Scholar
  • 7 Xing W, Chen W, Sheng J. et al. Sixty-four-row multislice computed tomographic angiography in the diagnosis and characterization of intracranial aneurysm: comparison with 3D rotational angiography. World Neurosurg 2011; 76 (1,2) 105-113
    CrossrefPubMedGoogle Scholar
  • 8 Alberico RA, Patel M, Casey S, Jacobs B, Maguire W, Decker R. Evaluation of the circle of Willis with three-dimensional CT angiography in patients with suspected intracranial aneurysms. AJNR Am J Neuroradiol 1995; 16 (08) 1571-1578 discussion 1579–1580
    PubMedGoogle Scholar
  • 9 Anderson GB, Steinke DE, Petruk KC. Computer tomography angiography versus digital subtraction angiography for the diagnosis and early treatment of ruptured intracranial aneurysms. Neurosurgery 1999; 45 (06) 1320-1322
    CrossrefPubMedGoogle Scholar
  • 10 Chappel ET, Moure FC, Good MC. Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms: a meta-analysis. Neurosurgery 2003; 52 (03) 624-631
    CrossrefPubMedGoogle Scholar
  • 11 Méndez AMZ, Rosas NPP, Guerra JCL. et al. Computed tomography angiography with three-dimensional reconstruction versus rotational angiography as a screening test in patients wilth suspected cerebral aneurysm. Indian J Neurosurgery 2016; 5 (02) 95-100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Ligon BL. Biography: history of developments in imaging techniques: Egas Moniz and angiography. Semin Pediatr Infect Dis 2003; 14 (02) 173-181
    CrossrefPubMedGoogle Scholar
  • 13 Zhang H, Hou C, Zhou Z, Zhang H, Zhou G, Zhang G. Evaluating of small intracranial aneurysms by 64-detector CT angiography: a comparison with 3-dimensional rotation DSA or surgical findings. J Neuroimaging 2014; 24 (02) 137-143
    CrossrefPubMedGoogle Scholar
  • 14 Pradilla G, Wicks RT, Hadelsberg U. et al. Accuracy of computed tomography angiography in the diagnosis of intracranial aneurysms. World Neurosurg 2013; 80 (06) 845-852
    CrossrefPubMedGoogle Scholar
  • 15 Chan S, Conti F, Salisbury K, Blevins NH. Virtual reality simulation in neurosurgery: technologies and evolution. Neurosurgery 2013; 72 (Suppl. 01) 154-164
    CrossrefPubMedGoogle Scholar
  • 16 Kumar A, Kato Y, Motoharu H. et al. An update on three-dimensional ct angiography in aneurysms: a useful modality for a neurosurgeon. Turk Neurosurg 2013; 23 (03) 304-311
    PubMedGoogle Scholar
  • 17 Mo DP, Bao SD, Li L, Yi ZQ, Zhang JY, Zhang Y. Virtual reality system for diagnosis and therapeutic planning of cerebral aneurysms. Chin Med J (Engl) 2010; 123 (16) 2206-2210
    PubMedGoogle Scholar
  • 18 Kumar A, Kato Y, Motoharu H. et al. An update on three-dimensional ct angiography in aneurysms: a useful modality for a neurosurgeon. Turk Neurosurg 2013; 23 (03) 304-311
    PubMedGoogle Scholar
  • 19 Safavi-Abbasi S, Moron F, Sun H. et al. Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms. J Neurosurg 2016; 125 (03) 720-729
    CrossrefPubMedGoogle Scholar
  • 20 He H, Chen C, Li W. et al. Contralateral approach based on a preoperative 3-dimensional virtual osteotomy technique for anterior circulation aneurysms. J Stroke Cerebrovasc Dis 2019; 28 (04) 1099-1106
    CrossrefPubMedGoogle Scholar
  • 21 Chivukula VK, Levitt MR, Clark A. et al. Reconstructing patient-specific cerebral aneurysm vasculature for in vitro investigations and treatment efficacy assessments. J Clin Neurosci 2019; 61: 153-159
    CrossrefPubMedGoogle Scholar
  • 22 Goertz L, Kabbasch C, Borggrefe J. et al. Preoperative three-dimensional angiography may reduce ischemic complications during clipping of ruptured intracranial aneurysms. World Neurosurg 2018; 120: e1163-e1170
    CrossrefPubMedGoogle Scholar
  • 23 Cebral JR, Fernando Mut F, Gade P. et al. Combining data from multiple sources to study mechanisms of aneurysm disease: tools and techniques. Int J Numer Methods Biomed Eng 2018; 34 (11) e3133
    CrossrefPubMedGoogle Scholar
  • 24 Matsukawa H, Kamiyama H, Miyazaki T. et al. Surgical treatment of middle cerebral artery aneurysms: aneurysm location and size ratio as risk factors for neurologic worsening and ischemic complications. World Neurosurg 2018; 117: e563-e570
    CrossrefPubMedGoogle Scholar
  • 25 Liu X, Tao H, Xiao X. et al. Use of the stereoscopic virtual reality display system for the detection and characterization of intracranial aneurysms: a Icomparison with conventional computed tomography workstation and 3D rotational angiography. Clin Neurol Neurosurg 2018; 170: 93-98
    CrossrefPubMedGoogle Scholar
  • 26 Alaraj A, Luciano CJ, Bailey DP. et al. Virtual reality cerebral aneurysm clipping simulation with real-time haptic feedback. Neurosurgery 2015; 11 (Suppl. 02) (02) 52-88
    PubMedGoogle Scholar