Abstract
Anterior-communicating artery (ACoA) aneurysms have diverse configurations and anatomical variations. The evaluation and operative treatment of these aneurysms necessitates a perfect surgical strategy based on review of three-dimensional (3D) angioarchitecture using several radiologic imaging methods. We analyzed the influence of 3D virtual reality (VR) reconstructions versus conventional computed tomography angiography (CTA) scans on the identification of vascular anatomy and on surgical planning in patients with unruptured ACoA aneurysms. Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative CTA scans were retrospectively reconstructed to 3D-VR images and visualized via VR software to detect the characteristics of unruptured ACoA aneurysms. A questionnaire was used to evaluate the influence of VR on the identification of aneurysm morphology and relevant arterial anatomy and on surgical strategy. Twenty-six patients were included and 520 answer sheets were evaluated. The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping. Thus, reconstruction of conventional preoperative CTA scans into 3D images and the spatial presentation in VR models enabled greater understanding of the anatomy and pathology, provided realistic haptic feedback for aneurysm surgery, and influenced operation planning and strategy.
Highlights
Unruptured intracranial aneurysms (UIAs) affect approximately 3% of the adult population [1,2]and are usually diagnosed incidentally in individuals who are prescribed cerebral imaging for otherBrain Sci. 2020, 10, 963; doi:10.3390/brainsci10120963 www.mdpi.com/journal/brainsciBrain Sci. 2020, 10, 963 reasons [3]
We retrospectively evaluate a cohort of patients who underwent surgical treatment for unruptured anterior communicating artery (ACoA) aneurysms
In our retrospective study to evaluate the impact of the image visualization modality on surgical planning in patients with unruptured ACoA aneurysm, the way in which sectional images were viewed significantly influenced the identification of aneurysm-related anatomical structures and an important part of the recommended surgical strategy
Summary
Brain Sci. 2020, 10, 963 reasons [3] Development of these imaging techniques and their increased use in clinical practice has led to the increasing detection of UIAs [4]. Unruptured anterior communicating artery (ACoA) aneurysms are one of the most frequent sites of intracranial aneurysms [6] and are those most likely to rupture [7] These aneurysms are known to have diverse configurations and complex flow conditions in the anterior circulation [8]. They are commonly treated surgically (clipping) or endovascularly (coiling) [9]. The risk of aneurysm rupture needs to be weighed against the risk of treatment complications [11]
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