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. 2022 Aug;45(4):2887-2894.
doi: 10.1007/s10143-022-01794-4. Epub 2022 May 12.

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Eike Schwandt  1 , Ralf Kockro  2 , Andreas Kramer  1 , Martin Glaser  1 , Florian Ringel  3
Affiliations

Presurgical selection of the ideal aneurysm clip by the use of a three-dimensional planning system

Eike Schwandt et al. Neurosurg Rev. 2022 Aug.

Abstract

Aneurysm occlusion rate after clipping is higher than after endovascular treatment. However, a certain percentage of incompletely clipped aneurysms remains. Presurgical selection of the proper aneurysm clips could potentially reduce the rate of incomplete clippings caused by inadequate clip geometry. The aim of the present study was to assess whether preoperative 3D image-based simulation allows for preoperative selection of a proper aneurysm clip for complete occlusion in individual cases. Patients harboring ruptured or unruptured cerebral aneurysms prior to surgical clipping were analyzed. CT angiography images were transferred to a 3D surgical-planning station (Dextroscope®) with imported models of 58 aneurysm clips. Intracranial vessels and aneurysms were segmented and the virtual aneurysm clips were placed at the aneurysm neck. Operating surgeons had information about the selected aneurysm clip, and patients underwent clipping. Intraoperative clip selection was documented and aneurysm occlusion rate was assessed by postoperative digital subtraction angiography. Nineteen patients were available for final analysis. In all patients, the most proximal clip at the aneurysm neck was the preselected clip. All aneurysms except one were fully occluded, as assessed by catheter angiography. One aneurysm had a small neck remnant that did not require secondary surgery and was occluded 15 months after surgery. 3D image-based preselection of a proper aneurysm clip can be translated to the operating room and avoids intraoperative clip selection. The associated occlusion rate of aneurysms is high.

Keywords: Aneurysm remnant; Cerebral aneurysm; Clipping; Simulation.

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Conflict of interest statement

ES and RK declare no competing interests; AK is a consultant to Brainlab; MG is a consultant to Medtronic, Abbott, LivaNova, and Nevro; FR receives royalties from Spineart, is a consultant to Spineart, Brainlab, Stryker, Interventional Systems, and receives money for presentations from Spineart, Stryker, and Icotec.

Figures

Fig. 1
Fig. 1
Dextroscope® 3D workstation
Fig. 2
Fig. 2
Collection of aneurysm clips imported to the Dextroscope® planning station. Each clip is an individual 3D object which is movable in all planes without any limitation. Thereby, simulation of different clipping scenarios is possible
Fig. 3
Fig. 3
Illustrative case showing A a pericallosal artery aneurysm in DSA and B CTA segmented in the planning station. C and D Show the preoperative virtual selection of an adequate clip, E and F the intraoperative placement of the clip at the aneurysm neck, G and H the postoperative imaging result
Fig. 4
Fig. 4
Flow chart of patients
See this image and copyright information in PMC

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