Aneurysm Surgery with Preoperative Three-Dimensional Planning in a Virtual Reality Environment: Technique and Outcome Analysis.
OBJECTIVE
Aneurysm surgery demands precise spatial understanding of the vascular anatomy and its surroundings. We report on a decade of experience planning clipping procedures preoperatively in a virtual reality (VR) workstation and present outcomes with respect to mortality, morbidity, and aneurysm occlusion rate.


METHODS
Between 2006 and 2015, the clipping of 115 intracranial aneurysms in 105 patients was preoperatively planned with the Dextroscope, a stereoscopic, patient-specific VR environment. The outcome data for all cases, planned and performed in 3 institutions, were analyzed based on clinical charts and radiologic reports.


RESULTS
Eighty-five incidental, unruptured aneurysms in 77 patients were electively planned and treated surgically. Mortality was 0% and morbidity (modified Rankin Scale score >2) was 2.6%. The rate of complete aneurysm obliteration on postoperative imaging was 91.8%. In addition, 30 aneurysms were treated in 28 patients with previous subarachnoid hemorrhage. Mortality in these cases was 3.6%, morbidity (modified Rankin Scale score >2) 7.1%, and the rate of complete aneurysm clipping was 90%.


CONCLUSIONS
Meticulous three-dimensional surgical planning in a VR environment enhances the surgeon's spatial understanding of the individual vascular anatomy and allows clip preselection and positioning as well as anticipation of potential difficulties and complications. VR planning was associated, in this multi-institutional series, with excellent clinical outcomes and rates of complete aneurysm closure equivalent to benchmark cohorts.
Department of Neurosurgery, Hirslanden Hospital, Zurich, Switzerland; Department of Neurosurgery, University Hospital Mainz, Mainz, Germany. Electronic address: ralf.kockro@hirslanden.ch.
Ralf A
RA
Kockro
Department of Neurosurgery, Hirslanden Hospital, Zurich, Switzerland.
Tim
T
Killeen
Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Ali
A
Ayyad
Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Martin
M
Glaser
Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Axel
A
Stadie
Department of Neurosurgery, Hirslanden Hospital, Zurich, Switzerland; Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Robert
R
Reisch
Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Alf
A
Giese
Department of Neurosurgery, University Hospital Mainz, Mainz, Germany.
Eike
E
Schwandt
D000328:Adult; D000368:Aged; D003198:Computer Simulation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D019635:Neurosurgical Procedures / Q000379:methods*; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D014584:User-Computer Interface
Clipping; Dextroscope; Intracranial aneurysm; Outcomes; Surgical planning; Virtual reality