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

  • Erkin Ozgiray (Department of Neurosurgery, Ege University School of Medicine) ;
  • Bugra Husemoglu (Department of Biomechanics, Dokuz Eylul University Health Science Institution) ;
  • Celal Cinar (Department of Radiology, Ege University School of Medicine) ;
  • Elif Bolat (Department of Neurosurgery, Ege University School of Medicine) ;
  • Nevhis Akinturk (Department of Neurosurgery, Ege University School of Medicine) ;
  • Huseyin Biceroglu (Department of Neurosurgery, Ege University School of Medicine) ;
  • Ceren Kizmazoglu (Department of Neurosurgery, Dokuz Eylul University School of Medicine)
  • Received : 2023.02.16
  • Accepted : 2023.09.08
  • Published : 2024.03.01

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.

Keywords

References

  1. Bakker NA, Metzemaekers JD, Groen RJ, Mooij JJ, Van Dijk JM : International Subarachnoid Aneurysm Trial 2009: endovascular coiling of ruptured intracranial aneurysms has no significant advantage over neurosurgical clipping. Neurosurgery 66 : 961-962, 2010 https://doi.org/10.1227/01.NEU.0000368152.67151.73
  2. Cavallo C, Safavi-Abbasi S, Kalani MYS, Gandhi S, Sun H, Oppenlander ME, et al. : Pulmonary complications after spontaneous aneurysmal subarachnoid hemorrhage: experience from barrow neurological institute. World Neurosurg 119 : e366-e373, 2018 https://doi.org/10.1016/j.wneu.2018.07.166
  3. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. : Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43 : 1711-1737, 2012 https://doi.org/10.1161/STR.0b013e3182587839
  4. Fotakopoulos G, Tsianaka E, Fountas K, Makris D, Spyrou M, Hernesniemi J : Clipping versus coiling in anterior circulation ruptured intracranial aneurysms: a meta-analysis. World Neurosurg 104 : 482-488, 2017 https://doi.org/10.1016/j.wneu.2017.05.040
  5. Hernesniemi J, Ishii K, Niemela M, Kivipelto L, Fujiki M, Shen H : Subtemporal approach to basilar bifurcation aneurysms: advanced technique and clinical experience. Acta Neurochir Suppl 94 : 31-38, 2005 https://doi.org/10.1007/3-211-27911-3_6
  6. Hernesniemi J, Koivisto T : Comments on "The impact of the International Subarachnoid Aneurysm Treatment Trial (ISAT) on neurosurgical practice". Acta Neurochir (Wien) 146 : 203-208, 2004 https://doi.org/10.1007/s00701-003-0098-y
  7. Hernesniemi J, Niemela M : Clipping of a ruptured aneurysm with clot removal in one session: still gold standard of treatment. World Neurosurg 74 : 579-580, 2010 https://doi.org/10.1016/j.wneu.2010.07.013
  8. Jabbarli R, Wrede KH, Pierscianek D, Dammann P, El Hindy N, Ozkan N, et al. : Outcome after clipping of unruptured intracranial aneurysms depends on caseload. World Neurosurg 89 : 666-671.e1, 2016 https://doi.org/10.1016/j.wneu.2015.12.043
  9. Kimura T, Morita A, Nishimura K, Aiyama H, Itoh H, Fukaya S, et al. : Simulation of and training for cerebral aneurysm clipping with 3-dimensional models. Neurosurgery 65 : 719-726; discussion 725-726, 2009 https://doi.org/10.1227/01.NEU.0000354350.88899.07
  10. Lehecka M, Dashti R, Lehto H, Kivisaari R, Niemela M, Hernesniemi J : Distal anterior cerebral artery aneurysms. Acta Neurochir Suppl 107 : 15-26, 2010 https://doi.org/10.1007/978-3-211-99373-6_3
  11. Mashiko T, Kaneko N, Konno T, Otani K, Nagayama R, Watanabe E : Training in cerebral aneurysm clipping using self-made 3-dimensional models. J Surg Educ 74 : 681-689, 2017 https://doi.org/10.1016/j.jsurg.2016.12.010
  12. Mashiko T, Otani K, Kawano R, Konno T, Kaneko N, Ito Y, et al. : Development of three-dimensional hollow elastic model for cerebral aneurysm clipping simulation enabling rapid and low cost prototyping. World Neurosurg 83 : 351-361, 2015
  13. Molyneux AJ, Birks J, Clarke A, Sneade M, Kerr RS : The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the international subarachnoid aneurysm trial (ISAT). Lancet 385 : 691-697, 2015 https://doi.org/10.1016/S0140-6736(14)60975-2
  14. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. : International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366 : 809-817, 2005 https://doi.org/10.1016/S0140-6736(05)67214-5
  15. Nanda A, Patra DP, Bir SC, Maiti TK, Kalakoti P, Bollam P : Microsurgical clipping of unruptured intracranial aneurysms: a single surgeon's experience over 16 years. World Neurosurg 100 : 85-99, 2017 https://doi.org/10.1016/j.wneu.2016.12.099
  16. Park SE, Park EK, Shim KW, Kim DS : Modified cranioplasty technique using 3-dimensional printed implants in preventing temporalis muscle hollowing. World Neurosurg 126 : e1160-e1168, 2019 https://doi.org/10.1016/j.wneu.2019.02.221
  17. Ploch CC, Mansi CSSA, Jayamohan J, Kuhl E : Using 3D printing to create personalized brain models for neurosurgical training and preoperative planning. World Neurosurg 90 : 668-674, 2016 https://doi.org/10.1016/j.wneu.2016.02.081
  18. Ryan JR, Almefty KK, Nakaji P, Frakes DH : Cerebral aneurysm clipping surgery simulation using patient-specific 3D printing and silicone casting. World Neurosurg 88 : 175-181, 2016 https://doi.org/10.1016/j.wneu.2015.12.102
  19. Song J, Kim BS, Shin YS : Treatment outcomes of unruptured intracranial aneurysm; experience of 1,231 consecutive aneurysms. Acta Neurochir (Wien) 157 : 1303-1311, 2015 https://doi.org/10.1007/s00701-015-2460-2
  20. Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Nakaji P, et al. : Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg 132 : 771-776, 2019
  21. Spetzler RF, Zabramski JM, McDougall CG, Albuquerque FC, Hills NK, Wallace RC, et al. : Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. J Neurosurg 128 : 120-125, 2018 https://doi.org/10.3171/2016.9.JNS161301
  22. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. : European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 35 : 93-112, 2013 https://doi.org/10.1159/000346087
  23. Tulamo R, Frosen J, Hernesniemi J, Niemela M : Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg 10(Suppl 1) : i58-i67, 2018 https://doi.org/10.1136/jnis.2009.002055.rep
  24. Wang L, Ye X, Hao Q, Chen Y, Chen X, Wang H, et al. : Comparison of two three-dimensional printed models of complex intracranial aneurysms for surgical simulation. World Neurosurg 103 : 671-679, 2017 https://doi.org/10.1016/j.wneu.2017.04.098
  25. Wang L, Ye X, Hao Q, Ma L, Chen X, Wang H, et al. : Three-dimensional intracranial middle cerebral artery aneurysm models for aneurysm surgery and training. J Clin Neurosci 50 : 77-82, 2018 https://doi.org/10.1016/j.jocn.2018.01.074
  26. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, et al. : Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362 : 103-110, 2003 https://doi.org/10.1016/S0140-6736(03)13860-3