J Korean Neurosurg Soc.  2024 Mar;67(2):166-176. 10.3340/jkns.2023.0035.

The Effect of Preoperative Three Dimensional Modeling and Simulation on Outcome of Intracranial Aneursym Surgery

• Ozgıray E
• Husemoglu B
• Cınar C
• Bolat E
• Akınturk N
• Bıceroglu H
• Kızmazoglu C

• KMID: 2553122
• DOI: http://doi.org/10.3340/jkns.2023.0035

Abstract

Objective
: Three-dimensional (3D) printing in vascular surgery is trending and is useful for the visualisation of intracranial aneurysms for both surgeons and trainees. The 3D models give the surgeon time to practice before hand and plan the surgery accordingly. The aim of this study was to examine the effect of preoperative planning with 3D printing models of aneurysms in terms of surgical time and patient outcomes.
Methods
: Forty patients were prospectively enrolled in this study and divided into two groups : groups I and II. In group I, only the angiograms were studied before surgery. Solid 3D modelling was performed only for group II before the operation and was studied accordingly. All surgeries were performed by the same senior vascular neurosurgeon. Demographic data, surgical data, both preoperative and postoperative modified Rankin scale (mRS) scores, and Glasgow outcome scores (GOS) were evaluated.
Results
: The average time of surgery was shorter in group II, and the difference was statistically significant between the two groups (p<0.001). However, no major differences were found for the GOS, hospitalisation time, or mRS.
Conclusion
: This study is the first prospective study of the utility of 3D aneurysm models. We show that 3D models are useful in surgery preparation. In the near future, these models will be used widely to educate trainees and pre-plan surgical options for senior surgeons.

Keyword

3D printing; Cerebral aneurysm; Surgical model

Figure

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  Fig. 1. A : Computed tomography (CT) image shows a partially thrombosed aneurysm with a wide neck (arrow) at the left proximal A1 level in a 49-year-old female patient. B : Digital subtraction angiography (DSA) image shows saccular aneurysms at the level of the left proximal A1 and anterior communicating artery (arrows). C : After stent and coil embolization of the proximal A1 and anterior communicating artery aneurysms (arrows). D : On follow-up DSA, the anterior communicating artery aneurysm (white arrow) showed an increase in size. E : The distal end of the stent does not appear to cover the anterior communicating artery aneurysm (arrow). CT angiography after (F) clipping of the anterior communicating artery aneurysm.

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  Fig. 2. Patient-specific three-dimensional model. A : Isotropic view of a solid model in Meshmixer (Autodesk Inc., San francisco, CA, USA). B : Using Meshmixer to make a burr hole. C : Using Meshmixer for mini-craniotomy

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  Fig. 3. A : Three-dimensional (3D) printed Aneurysm model fixed with Mayfield head holder. B and C : Craniotomy was done and top view after printing of an anterior communicating artery aneurysm, (D) on the 3D printed model, clipping angle was simulated via left supraorbital approach. E : Intraoperative images still depicting a residual anterior communicating artery aneurysm before and (F) after clipping. ICA : internal carotid artery.

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  Fig. 4. A 42-year-old male patient had an incidentally found right middle cerebral artery (MCA) bifurcation aneurysm. A : Digital subtraction angiography (DSA) depicting a right MCA aneurysm with a wide neck (arrow). B : Computed tomography (CT) image after endovascular treatment revealing the stent and coil (arrow). C : Two years after endovascular treatment, magnetic resonance angiography image shows newly developing microaneurysms at the level of the left MCA bifurcation (arrow). D : After endovascular treatment of left MCA aneurysms. The stent is depicted on the CT image (arrow). E : Four years after endovascular treatment, the control DSA image shows a newly developed saccular aneurysm at the level of the anterior choroidal artery (arrow). F : The saccular aneurysm was clipped via the left pterional approach. On postoperative CT, the aneurysm clip is depicted (arrow).

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  Fig. 5. A and B : Computed tomography angiography images was used to reconstruct multiple aneurysms (arrows) model of the patient. C and D : Showing three-dimensional printed model of the aneurysms (arrows).

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  Fig. 6. A left anterior choroidal artery aneurysm (white arrow) is observed before (A) and after clipping (B). Doppler ultrasonography is routinely employed during all aneurysm surgeries. In Fig. 3B, the patency of the parent artery is confirmed.

Reference

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