Craniotomy and Clipping of Intracranial Aneurysm in a Stereoscopic Virtual Reality Environment: Technical Note and Illustrations

Objective: The release of results of the International Subarachnoid Aneurysm Trial (ISAT) in 2003 caused a shift in the paradigm of management of ruptured intracranial aneurysm. The microsurgical clipping cases today are usually aneurysms that are not suitable for embolization, at times complex and difficult. We devised an innovative application of operative planning and training for craniotomy and microsurgical clipping of intracranial aneurysm in a stereoscopic virtual reality environment.

Method: Patient-specific DICOM data of computed tomographic angiography of the intracranial circulation and skull were transferred into the workstation (Dextroscope, Volume Interactions Pte., Ltd.). An aneurysm clip database was loaded into the patient dataset. 3D volume rendering was followed by data coregistration and fusion.

Result: Virtual head positioning and craniotomy were carried out to simulate the microscopic visualization. Clip selection could be carried out with reference to the angle of application. This allows the surgeon to see the exposure and degree of obliteration of an aneurysm with the different angles of approach.

Conclusion: The virtual craniotomy and microsurgical clipping application simulated the operative environment encountered. Its role in neurosurgical training was encouraging and should be further developed.