Simulation of and Training for Cerebral Aneurysm Clipping With 3-Dimensional Models

Abstract

Some reports have addressed the use of three-dimensional (3-D) models in simulated clipping of cerebral aneurysms. To report on the effectiveness of these models, for this study, we developed two types of 3-D models for use in clipping simulations and for clarifying angioarchitecture and surgical approaches. The two types of model, one made of acrylic polymer and the other made of hollow silicone, were fabricated with a 3-D printer using data obtained with 3-D digital subtraction angiography (3D-DSA). The hollow silicone model was used for simulated clipping, whereas the acrylic model was used as a tool for clarifying angioarchitecture and surgical approaches. We performed simulated clipping of ce-rebral aneurysms with the two types of 3-D model for 10 patients with 11 cerebral aneurysms. In 6 of the 11 aneurysms, the first clips accorded with the clipping simulations. The remaining 4 aneu-rysms exhibited only slight variation from the simulations. In 1 of the 11 aneurysms, the lengths and shapes of the first clips did not accord with the clipping simulations. The hollow silicone model was effective at aiding in the proper selection and manipulation of the clips. The acrylic model was effective at confirming the surgical approach, aneurysm depth, and backside angioarchitecture. Moreover, the procedures were performed smoothly with a microscope without the need to use the monitor, as it was utilized in a clean field. These two types of 3-D model helped the surgeons gain a clear and intuitive understanding of aneu-rysm and angioarchitecture in three dimensions. As a result, they were highly useful for simulating clip application.

Preoperative Simulations of Endovascular Treatment for a Cerebral Aneurysm Using a Patient-Specific Vascular Silicone Model

“…2,4,5,9,10,12) Kimura et al 7) described preoperative simulations for cerebral aneurysm clipping with 3D models. Although this is a single case, we demonstrated that preoperative endovascular simulations using patient-specific vascular models are also feasible and helpful for designing a treatment strategy and may reduce the risk of complications.…”

“…Patient-specific vascular silicone models are made using cadaver specimens 3,6,9) or three-dimensional (3D) vascular images of patients. 1,7,11) Kimura et al 7) described preoperative simulations for cerebral aneurysm clipping with 3D models. We report, for the first time, preoperative endovascular simulations for cerebral aneurysms using a patientspecific silicone model.…”

Unruptured Intracranial Aneurysms: Current Perspectives on the Origin and Natural Course, and Quest for Standards in the Management Strategy

“…These models were very useful in deciding how to apply clips to occlude the closure line of the aneurysm and combination of aneurysm clips for complex-shaped aneurysms. 11) Electrophysiological monitoring: Electrophysiological monitoring is essential to reduce operative complications. Motor evoked potential monitoring is very useful for reducing managing morbidity during aneurysm surgery, especially around the perforating branches such as the anterior choroidal, posterior communicating, M 1 , and vertebro-basilar arteries.…”

How do we maintain competence in aneurysm surgery

“…Not only the number (quantity) but also the diversity (quality) of cases may become so limited as to endanger, frustrate, or even make it impossible to secure the objective of mastering the surgical technique required in the surgical treatment of aneurysms. Adaptation to this new reality has prompted technology and imagination with new solutions, such as the development of software applications, surgical simulators, and even prototype models of diseased vessels [6]. These alternatives tend to recreate the problems and gestures one is usually faced with when performing a real surgery, allowing for some part of the necessary training to be acquired on a dummy model and not at the cost of the patient, thereby shortening the surgical caseload learning curve.…”

“…Unfortunately, these techniques are still at an early stage of development and their application remains quite variable depending on the type or surgical act [2,6].…”