Cerebral Aneurysmal Coiling in Virtual Reality ‐ An Overview of Novice Skill Development

Abstract

Introduction and AimsCerebral endovascular aneurysm coiling is an interventional angiography technique which requires the use of fine motor and visuo‐spatial skills in order to guide tools throughout relevant vascular anatomy and deposit coils within the aneurysm. With the help of quantitatively limited fluoroscopy, coils are established through microcatheter placement in the aneurysm neck and electrolytically detached after their appropriate rotation and positioning. This procedure requires, and is currently limited to, extensive clinical training in the AngioSuite, where trainees are closely supervised by a consultant. This approach, although providing the current gold standard in training, limits the pace of skill development, exposes patients to unnecessary risk and wastes valuable monetary and personnel resources. The development of the skills needed for these procedures can be facilitated by 3D simulator‐based training. Simulation‐based medical education has recently started focusing on personalized training in reducing errors and development of specific skills.The ANGIO Mentor visual‐haptic simulator has been regarded as an effective training tool, increasing performance in diagnostic cerebral angiography, however, this simulator has not been tested thoroughly in its ability to train interventional skills. In particular, the details of the aneurysm coiling process during simulation‐based training have not been assessed.MethodsIn this study, 12 novice medical students were given simulation‐based diagnostic cerebral angiography training until a procedural plateau in performance, established in our previous work (Zaika et al., 2016). Subsequently, they were trained using video tutorials and written instructions to identify, measure and intervene with cerebral aneurysms using endovascular coils. Over the span of 6 sessions, participants were assessed on their procedural pace, coiling quantity and quality, and perforation rates. Concurrently, their spatial ability was assessed using a mental rotations test (MRT) and used in the performance analysis.Results and DiscussionWe found that all individuals were able to perform the procedure faster after 6 sessions, reducing their average time from 42 to 24 minutes. Coil success rate improved over from 82% to 88% and coil packing rate remained consistent at 30% throughout testing. High perforation rate seen at the start of the study showed a trend of decreasing over the latter sessions, however, over half of aneurysms were still being perforated by the novice participants. No change in aneurysm coiling quality was found, with a slight decrease in number of parent artery coil protrusions. High MRT individuals were also better able to establish guider catheter and associate tools prior to coiling. This work identifies the utility of simulation‐based cerebral angiography training in identifying the particular difficulties trainees experience in learning procedural skills, including prevention of perforations, proper positioning and success of coils within the aneurysm.Support or Funding InformationThis research was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and the Canadian Institutes of Health Research (CIHR).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.