Clipping of Posterior Circulation Intracranial Aneurysms: Maintenance of a Necessary Skill in Low-Resource Settings

Abstract

The treatment paradigm for intracranial aneurysms has evolved with technological advancements, resulting in improved patient outcomes. In particular, the management of posterior circulation aneurysms has shifted to favor endovascular therapy (EVT). However, this modality is not always accessible in low-resource settings. In our country (Trinidad and Tobago), neuroendovascular services are not readily available. We report a case of a patient with a ruptured left posterior inferior cerebellar artery (PICA) aneurysm (Fisher grade 4) who underwent a far-lateral craniotomy and clip ligation. It was done by a fellowship-trained vascular neurosurgeon in a public hospital and resulted in an excellent patient outcome. This highlights the need to maintain this surgical skill set in resource-poor countries, in spite of the increasing popularity of endovascular therapy.

Training Performance Assessment for Intracranial Aneurysm Clipping Surgery Using a Patient-Specific Mixed-Reality Simulator: A Learning Curve Study

“…[7][8][9] If simulation training is available, it could be beneficial especially in low-resource settings. 10 Moreover, practitioners can use simulation tools to experiment with novel treatment approaches for complex IA cases in specific patients.…”

Dynamic Mixed-Reality Patient-Specific Aneurysm Clipping Simulation for Two Cases—A Feasibility Study

“…[1][2][3][4] However, in these studies, the 3-dimensional (3D) models lack haptics and tactile feeling of the pathology, which neurosurgeons acknowledge as an additional feature for clip selection and clipping strategy design. [5][6][7] To address this limitation, simulations including 3D-printed aneurysm models have been developed and have reported promising results in preoperative real-patient case planning. Some challenges remain, especially regarding replication complexity, scalability, and accuracy in reproducing mechanical properties, such as wall elasticity and blood fluid mechanics.…”