Abstract TMP4: Computational Fluid Dynamics Analysis Offers Novel Preoperative Insights for Unruptured Cerebral Aneurysms - Predicting Aneurysm Wall Thinning and Thickening -

Abstract

Objective: The preoperative identification of thin-walled regions (TIWRs) and thick-walled regions (TKWRs) in cerebral aneurysms can contribute to enhancing surgical safety. Our recent computational fluid dynamics (CFD) analysis of cerebral aneurysms has demonstrated that the wall shear stress vector cycle variation (WSSVV) and the oscillatory shear index (OSI) can potentially predict TIWRs and TKWRs. This study aims to validate the accuracy of using WSSVV and the OSI to identify these areas and to report on their effectiveness in actual surgeries. Methods: Our cohort comprised 42 patients who underwent cerebral aneurysm clipping surgery at our hospital from January 2019 to September 2022. CFD analysis was performed using Hemoscope. We defined suspected TIWRs as blue regions and suspected TKWRs as red regions on both color maps. We evaluated the positive predictive value (PPV) by comparing these preoperative suspected areas with actual thin and thick areas determined intraoperatively under surgical microscopic observation. Results: Of the 42 patients, 15 were male and 27 were female. The average age was 63 years, and the average aneurysm size was 5.9 mm. The location of the aneurysms was the middle cerebral artery in 18 cases, the internal carotid artery in 15 cases, the anterior communicating artery in 8 cases, and the basilar artery in 1 case. WSSVV yielded a PPV of 83% for TIWRs and a PPV of 78% for TKWRs. In comparison, the OSI demonstrated a PPV of 77% for TIWRs and 76% for TKWRs. Spearman's rank correlation analysis revealed a strong correlation between WSSVV and the OSI; the correlation coefficient was 0.883 (p-value < 0.001). Conclusions: CFD analysis of unruptured cerebral aneurysms could be used to predict TIWRs and TKWRs using both WSSVV and the OSI with an accuracy of approximately 80%. The preoperative evaluation of the wall condition using CFD analysis appears to be highly reliable and is likely to contribute to the safety of cerebral aneurysm surgery.