Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Schwandt, Eike; Kockro, Ralf A.; Kramer, Andreas H.; Gläser, Martin; Ringel, Florian

doi:10.1007/s10143-022-01794-4

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…VR systems do not have preservation problems, and they have been highly investigated for planning [ 43 - 45 ], focusing on force feedback, distance visualization, or a craniotomy approach [ 46 - 48 ]. Participants in VR studies could clip aneurysms multiple times, but training for the surgical experience was unrealistic although the simulation created an immersive environment.…”

Section: Discussionmentioning

confidence: 99%

Simulation training approaches in intracranial aneurysm surgery—a systematic review

2023

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Background With the increasing complexity and decreasing exposure to intracranial aneurysm surgery, training and maintenance of the surgical skills have become challenging. This review elaborated on simulation training for intracranial aneurysm clipping. Methods A systematic review was performed according to the PRISMA guidelines to identify studies on aneurysm clipping training using models and simulators. The primary outcome was the identification of the predominant modes of the simulation process, models, and training methods associated with a microsurgical learning curve. The secondary outcomes included assessments of the validation of such simulators and the learning capability from the use of such simulators. Results Of the 2068 articles screened, 26 studies met the inclusion criteria. The chosen reports used a wide range of simulation approaches including ex vivo methods (n = 6); virtual reality (VR) platforms (n = 11); and static (n = 6) and dynamic (n = 3) 3D-printed aneurysm models (n = 6). The ex vivo training methods have limited availability, VR simulators lack haptics and tactility, while 3D static models lack important microanatomical components and the simulation of blood flow. 3D dynamic models including pulsatile flow are reusable and cost-effective but miss microanatomical components. Conclusions The existing training methods are heterogenous and do not realistically simulate the complete microsurgical workflow. The current simulations lack certain anatomical features and crucial surgical steps. Future research should focus on developing and validating a reusable, cost-effective training platform. No systematic validation method exists for the different training models, so there is a need to build homogenous assessment tools and validate the role of simulation in education and patient safety.

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Section: Discussionmentioning

confidence: 99%

Simulation training approaches in intracranial aneurysm surgery—a systematic review

2023

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“…Different assessment methods have been proposed to evaluate the impact of aneurysm simulators on both education and surgical planning. 12,34 A Japanese group presented a preclinical training program including two clipping sessions and an interim video review session, evaluated by an expert assessment based on Objective Structured Assessment of Technical Skills (OSATS). 29 Others have compared occlusion rates of novice versus experienced surgeons in preclinical settings.…”

Section: Objective Evaluation Of Our Simulator Training Programmentioning

confidence: 99%

“…In these cases, the rate of implant accordance, surgical complications, and procedural duration were reported to document trainees' performance. 30,34,41 Kimura et al proposed assessing the position of the clip and its neck coverage by an endoscope in the 3D-printed surgical situs. 41 Futami et al demonstrated the importance of CTA scans to assess aneurysm neck coverage after clipping as early as 2004.…”

Section: Simulator Training Improves Microsurgical Skills and Aneurys...mentioning

confidence: 99%

An evaluation of physical and augmented patient-specific intracranial aneurysm simulators on microsurgical clipping performance and skills: a randomized controlled study

Dodier,

Civilla,

Mallouhi

et al. 2024

Neurosurgical Focus

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OBJECTIVE In the era of flow diversion, there is an increasing demand to train neurosurgeons outside the operating room in safely performing clipping of unruptured intracranial aneurysms. This study introduces a clip training simulation platform for residents and aspiring cerebrovascular neurosurgeons, with the aim to visualize peri-aneurysm anatomy and train virtual clipping applications on the matching physical aneurysm cases. METHODS Novel, cost-efficient techniques allow the fabrication of realistic aneurysm phantom models and the additional integration of holographic augmented reality (AR) simulations. Specialists preselected suitable and unsuitable clips for each of the 5 patient-specific models, which were then used in a standardized protocol involving 9 resident participants. Participants underwent four sessions of clip applications on the models, receiving no interim training (control), a video review session (video), or a video review session and holographic clip simulation training (video + AR) between sessions 2 and 3. The study evaluated objective microsurgical skills, which included clip selection, number of clip applications, active simulation time, wrist tremor analysis during simulations, and occlusion efficacy. Aneurysm occlusions of the reference sessions were assessed by indocyanine green videoangiography, as well as conventional and photon-counting CT scans. RESULTS A total of 180 clipping procedures were performed without technical complications. The measurements of the active simulation times showed a 39% improvement for all participants. A median of 2 clip application attempts per case was required during the final session, with significant improvement observed in experienced residents (postgraduate year 5 or 6). Wrist tremor improved by 29% overall. The objectively assessed aneurysm occlusion rate (Raymond-Roy class 1) improved from 76% to 80% overall, even reaching 93% in the extensively trained cohort (video + AR) (p = 0.046). CONCLUSIONS The authors introduce a newly developed simulator training platform combining physical and holographic aneurysm clipping simulators. The development of exchangeable, aneurysm-comprising housings allows objective radio-anatomical evaluation through conventional and photon-counting CT scans. Measurable performance metrics serve to objectively document improvements in microsurgical skills and surgical confidence. Moreover, the different training levels enable a training program tailored to the cerebrovascular trainees’ levels of experience and needs.

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“…2a This concept is most apparent with the use of the VSP, which relies on data that can be obtained before treatment and provides helpful treatment information. While analogous work has been done with optimal clip placement based on preoperative imaging, 3a the major challenge with open surgery is not placing the clip, it is circumferential visualization of the aneurysm neck. Endovascular treatment is not limited by direct (or microscopic) visualization of the lesion, just radiographic imaging, which can be obtained prior to treatment.…”

Section: Commentsmentioning

confidence: 99%

A Novel Braided Stent With Customized Simulation Software for Treatment of Intracranial Aneurysms: Multicenter Prospective Trial Before Unrestricted Clinical Application

Kan,

Oishi,

Hyodo

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Planning/guidance software became important tools for physicians' presurgical optimal decision-making. However, there are no intracranial stent products with specifically associated simulation software. We report the “premarket” clinical trial of a new braided stent with a customized simulation software. METHODS: A stent system with 3 mesh density types (16, 24, and 32 wire mesh) was designed based on computational flow dynamics technology, and a simulation software (virtual stent planner [VSP]) was developed for the optimal stent deployment planning. Stents were selected after simulation on preoperative 3D-processed angioimages, and accuracy of the VSP was evaluated. RESULTS: Thirty-three unruptured intracranial aneurysms were successfully treated with VSP guidance. Twenty aneurysms (61%) were anterior circulation aneurysms, and 13 (39%) were posterior circulation aneurysms. The average aneurysm size was 7.1 mm, and the mean follow-up period was 19.2 months (11-39.0). There was no major recurrence or retreatment during follow-up, 2 morbidity cases, and no mortality. VSP planning presented slightly smaller stent dimensions compared with postdeployment: 24.2 vs 25.5 mm average, error —1.3 mm, and difference rate—5.46%. CONCLUSION: Based on this result, the new stents and software guidance system were approved by the Ministry of Health and Welfare as a combined medical device. VSP provided precise deployment with minimal error compared with actual stent and can contribute to better stent deployment even for less experienced physicians.

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Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Cited by 6 publications

References 42 publications

Simulation training approaches in intracranial aneurysm surgery—a systematic review

Simulation training approaches in intracranial aneurysm surgery—a systematic review

An evaluation of physical and augmented patient-specific intracranial aneurysm simulators on microsurgical clipping performance and skills: a randomized controlled study

A Novel Braided Stent With Customized Simulation Software for Treatment of Intracranial Aneurysms: Multicenter Prospective Trial Before Unrestricted Clinical Application

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