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. 2022 Jun 13;17(1):43-49.
doi: 10.1055/s-0042-1749148. eCollection 2022 Mar.

Depiction of Cerebral Aneurysm Wall by Computational Fluid Dynamics (CFD) and Preoperative Illustration

Riki Tanaka  1 , Boon Seng Liew  1 , Yasuhiro Yamada  1 , Kento Sasaki  1 , Kyosuke Miyatani  1 , Fuminari Komatsu  1 , Tsukasa Kawase  1 , Yoko Kato  1 , Yuichi Hirose  1
Affiliations

Depiction of Cerebral Aneurysm Wall by Computational Fluid Dynamics (CFD) and Preoperative Illustration

Riki Tanaka et al. Asian J Neurosurg. .

Abstract

Introduction Preoperative illustration is a part of an important exercise to study the configuration, direction, and presence of any perforations, and is the weakest point in the wall of the cerebral aneurysm. The same illustration is used to study the surrounding brain structures to decide the best and safe surgical approach prior to any surgical procedure. With the evolution of the aneurysm wall study and study of flow dynamic within the involved artery and its aneurysm wall using computational fluid dynamics (CFD), a better surgical plan can be formulated to improve the flow dynamics. As one of the clinical applications of CFD, we propose a study using a composite image that combines preoperative illustration and CFD, which is traditionally widely used in neurosurgery. Methods and Materials We study the use of illustrations of the unruptured cerebral aneurysm of internal carotid-posterior communicating (ICPC) artery and anterior communicating artery (AcomA) treated at our hospital. The combinations of both preoperative illustrations and CFD images by using "ipad Pro" were used. Result and Conclusion Medical illustration in the preoperative study of unruptured cerebral aneurysm with combinations of CFD and surrounding brain structures is helpful to decide the surgical approaches and successful surgical treatments.

Keywords: cerebral aneurysm; computational fluid dynamics; preoperative illustration; preoperative planning.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Single image of vessels with computational fluid dynamics (CFD). Limited information on the side (right/left), approach (pterional, interhemispheric) and vessels involved (middle cerebral artery, MCA, or AcomA).
Fig. 2
Fig. 2
Left ICPC artery saccular aneurysm. ICPC, internal carotid-posterior communicating.
Fig. 3
Fig. 3
Computational fluid dynamics (CFD) using the Amin Corporation ZIO station2 and Hemoscope. ( A ) Wall pressure showed higher wall pressure compared with the distal vessel. ( B ) The wall shear stress (WSS) showed low WSS indicating high risk of rupture especially over lateral wall of the dome. ( C ) The vector WSS showed divergent vectors indicating turbulence flow with the aneurysm sac. ( D ) The streamline indicating laminar flow directions within the aneurysm sac.
Fig. 4
Fig. 4
The extracted wall shear stress image of the ICPC artery aneurysm. ICPC, internal carotid-posterior communicating.
Fig. 5
Fig. 5
An anatomical illustration of the surrounding brain structures viewed from the pterional approach was made using the iPad pro (10.5 inch), Apple Pencil, and Procreate.
Fig. 6
Fig. 6
Combined images of CFD images of the ICPC artery aneurysm with the brain structures. ( A ) Combined images showed high wall pressure over the whole aneurysm sac with wide neck. ( B ) Combined images showed an aneurysm dome with low WSS indicating risk of rupture pointing toward the temporal lobe and the cranial nerve (CN) III (below the aneurysm sac). ( C ) The combined vector. ( D ) The streamline within the ICPC artery aneurysm. CFD, computational fluid dynamics; ICPC, internal carotid-posterior communicating; WSS, wall shear stress.
Fig. 7
Fig. 7
The comparison with the preoperative medical illustration and the actual microscopic view.
Fig. 8
Fig. 8
AcomA saccular aneurysm pointing right side in the top view.
Fig. 9
Fig. 9
The illustration of the structures seen in right pterional approach ( left ) and combination of both images including the one generated by CFD ( right ). CFD, computational fluid dynamics.
See this image and copyright information in PMC

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