IMPORTANCEThe risk of procedural clinical complications and the case-fatality rate (CFR) from preventive treatment of unruptured intracranial aneurysms varies between studies and may depend on treatment modality and risk factors. OBJECTIVE To assess current procedural clinical 30-day complications and the CFR from endovascular treatment (EVT) and neurosurgical treatment (NST) of unruptured intracranial aneurysms and risk factors of clinical complications.

BACKGROUND As current augmented-reality (AR) smart glasses are self-contained, powerful computers that project 3-dimensional holograms that can maintain their position in physical space, they could theoretically be used as a low-cost, stand-alone neuronavigation system. OBJECTIVE To determine feasibility and accuracy of holographic neuronavigation (HN) using AR smart glasses. METHODS We programmed a fully functioning neuronavigation system on commercially available smart glasses (HoloLens®, Microsoft, Redmond, Washington) and tested its accuracy and feasibility in the operating room. The fiducial registration error (FRE) was measured for both HN and conventional neuronavigation (CN) (Brainlab, Munich, Germany) by using point-based registration on a plastic head model. Subsequently, we measured HN and CN FRE on 3 patients. RESULTS A stereoscopic view of the holograms was successfully achieved in all experiments. In plastic head measurements, the mean HN FRE was 7.2 ± 1.8 mm compared to the mean CN FRE of 1.9 ± 0.45 (mean difference: –5.3 mm; 95% confidence interval [CI]: –6.7 to –3.9). In the 3 patients, the mean HN FRE was 4.4 ± 2.5 mm compared to the mean CN FRE of 3.6 ± 0.5 (mean difference: –0.8 mm; 95% CI: –3.0 to 4.6). CONCLUSION Owing to the potential benefits and promising results, we believe that HN could eventually find application in operating rooms. However, several improvements will have to be made before the device can be used in clinical practice.

This study demonstrates satisfactory results in the treatment of giant MCA aneurysms with an ELANA flow replacement bypass, considering the very grave natural history and treatment complexity of these lesions. The ELANA technique is a useful tool in the treatment armamentarium of the vascular neurosurgeon.

This study shows that the excimer laser-assisted nonocclusive anastomosis high-flow replacement bypass, which provides maximum brain protection because of its nonocclusive character, is a reliable and effective method to treat these otherwise untreatable patients.