Craniotomy and clipping of intracranial aneurysm in a stereoscopic virtual reality environment.
OBJECTIVE
The release of results of International Subarachnoid Aneurysm Trial in 2003 caused a shift in the paradigm of management of ruptured intracranial aneurysms. The cases selected for microsurgical clipping nowadays are usually those patients with aneurysms that are not suitable for embolization, and are often complex and difficult. We devised an innovative application of operative planning and training for craniotomy and microsurgical clipping of intracranial aneurysms in a stereoscopic virtual reality environment.


METHODS
Patient-specific Digital Imaging and Communications in Medicine data from computed tomographic angiography of the intracranial circulation and cranium were transferred to the workstation (Dextroscope; Volume Interactions Pte. Ltd., Singapore, Singapore). An aneurysm clip database was loaded into the patient data set. Three-dimensional volume rendering was followed by data coregistration and fusion.


RESULTS
Virtual head positioning and craniotomy were carried out to simulate the microscopic visualization. Clip selection could be carried out with reference to the angle of application. This allows one to see the exposure and degree of obliteration of an aneurysm with the various angles of approach.


CONCLUSIONS
The virtual craniotomy and microsurgical clipping application simulated the operative environment. Its role in neurosurgical training is encouraging and should be further developed.
Wong
George K C
GK
Department of Surgery, Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Zhu
Canon X L
CX
Ahuja
Anil T
AT
Poon
Wai S
WS
D003198:Computer Simulation; D003399:Craniotomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments