Craniotomy and clipping of intracranial aneurysm in a stereoscopic virtual reality environment.
ABSTRACT The release of results of International Subarachnoid Aneurysm Trial in 2003 caused a shift in the paradigm of management of ruptured intracranial aneurysms. The cases selected for microsurgical clipping nowadays are usually those patients with aneurysms that are not suitable for embolization, and are often complex and difficult. We devised an innovative application of operative planning and training for craniotomy and microsurgical clipping of intracranial aneurysms in a stereoscopic virtual reality environment.
Patient-specific Digital Imaging and Communications in Medicine data from computed tomographic angiography of the intracranial circulation and cranium were transferred to the workstation (Dextroscope; Volume Interactions Pte. Ltd., Singapore, Singapore). An aneurysm clip database was loaded into the patient data set. Three-dimensional volume rendering was followed by data coregistration and fusion.
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 one to see the exposure and degree of obliteration of an aneurysm with the various angles of approach.
The virtual craniotomy and microsurgical clipping application simulated the operative environment. Its role in neurosurgical training is encouraging and should be further developed.
- World Neurosurgery 01/2014; · 2.42 Impact Factor
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ABSTRACT: We developed a method for fabricating a 3D hollow and elastic aneurysm model useful for surgical simulation and surgical training. In this article, we explain the hollow elastic-model prototyping method and report on the effects of applying it to pre-surgical simulation and surgical training. A 3D printer using Acrylonitrile-Butadiene-Styrene (ABS) as a modeling material was used to produce a vessel model. The prototype was then coated with liquid silicone. After the silicone had hardened, the ABS was melted with xylene and removed leaving an outer layer as a hollow elastic-model. Simulations using the hollow-elastic model were performed in 12 cases. In all cases, the clipping proceeded as scheduled. The surgeon's postoperative assessment was favorable in all cases. This method enables easy fabrication at low cost. Simulation using hollow elastic-model is thought to be useful for facilitating an understanding of three-dimensional aneurysm structure.World Neurosurgery 10/2013; · 2.42 Impact Factor
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ABSTRACT: Neurosurgery in areas with restricted space and complicated anatomy can be greatly aided by the virtual reality (VR) technique. The clivus represents one of such challenging surgical areas, but its VR has not been established. The present study aimed to document a VR model of clival anatomy that may be useful in clival surgery. High resolution CT angiography and MRI were used. The study included a total of 20 patients who did not have any obvious abnormalities detected in the oral, nasal, and clival areas. The images were fused with a Dextroscope. In the VR model, the key structures such as the clival bone, basilar artery, brainstem, pituitary gland, and paranasal sinuses were clearly observed. The morphology of the clivus and its spatial relationships with the neighboring structures were also illustrated. Visualization of the clival model can be made flexible from various planes, angles, or orientations. In addition, surgical access to the clivus via the transoral route or transnasal route was simulated in detail. The simulation of the VR model offers a straightforward, three-dimensional, interactive understanding of the size and shape of the clivus, and its relationships with the surrounding blood vessels and bones. It also demonstrates simulated operational procedures such as opening the surgical window, measuring the exposure distance and angles, and determining the critical boundaries in relation to key structures such as the brainstem and arteries. Digitalized VR modeling appears to be helpful for understanding the anatomy of the clivus and its surgical approaches.International Journal of Clinical and Experimental Medicine 01/2014; 7(10):3270-3279. · 1.42 Impact Factor