VALIDATION OF A VIRTUAL ANEURYSM-CLIPPING SIMULATOR

Background: Improving the quality and efficiency of neurosurgical education in a safe and realistic environment is highly desirable. The caseload reduction due to endovascular treatment options has led to remaining cerebral aneurysms being more complex. One way to alleviate this problem is the integration of a virtual surgical simulator for the training of both standard procedures and complex cases into resident education. Therefore, the aim of this study was to develop and evaluate a patient-specific virtual aneurysm-clipping simulator. Methods: A prototype simulator with haptic force feedback and real-time deformation of the aneurysm and vessels has been developed. Assessment of virtual clipping success via blood flow simulation was included in the system, and the prototype was evaluated by 18 neurosurgeons. Virtual clipping was performed after real-life surgery for four patients with different medial cerebral artery (MCA) aneurysms, and the surgical results were compared with respect to clip application, surgical trajectory, and blood flow. Result: After positioning the patient's head and performing a virtual craniotomy, bimanual virtual aneurysm clipping was carried out using an original forceps attached to a haptic device. Residual aneurysm filling and branch stenosis was analyzed with blood flow simulation. 89% of the surveyed neurosurgeons said that the simulator improved anatomic understanding. Simulation of head positioning and craniotomy was considered realistic by 89% and 94% of users, respectively. Most participants agreed that the simulator should be integrated into neurosurgical education (94%). Discussion: Using four illustrative cases, we show that virtual aneurysm surgery was possible via the same trajectory as in the real-life cases. In the case of broad-based aneurysms, both virtual clipping and blood flow simulation yielded realistic results, whereas for calcified aneurysms, virtual clipping could be performed using the same surgical trajectory, but not the same clip type. Conclusion: We have successfully developed a virtual aneurysm-clipping simulator. Next, the prototype will be further improved and integrated into a hybrid simulation system. In its final form, it will also be applicable for surgical procedure planning.