Virtual cerebral aneurysm clipping with real-time haptic force feedback in neurosurgical education.

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Virtual cerebral aneurysm clipping with real-time haptic force feedback in neurosurgical education.

World Neurosurg. 2018 Jan 11;:

Authors: Gmeiner M, Dirnberger J, Fenz W, Gollwitzer M, Wurm G, Trenkler J, Gruber A

Abstract
OBJECTIVE: Realistic, safe and efficient modalities for simulation-based training are highly warranted to enhance the quality of surgical education and should be incorporated in resident training. The aim of this study was to develop a patient-specific virtual cerebral aneurysm-clipping simulator with haptic force-feedback and real-time deformation of the aneurysm and vessels.
METHODS: A prototype simulator was developed from 2012-2016. Evaluation of virtual clipping by blood flow simulation was integrated in this software and the prototype was evaluated by 18 neurosurgeons. In 4 patients with different medial cerebral artery aneurysms, virtual clipping was performed after real-life surgery and surgical results were compared regarding clip application, surgical trajectory and blood flow.
RESULTS: After head positioning and craniotomy, bimanual virtual aneurysm clipping with an original forceps was performed. Blood flow simulation demonstrated residual aneurysm filling or branch stenosis. For 89% of neurosurgeons the simulator improved anatomical understanding. Simulation of head positioning and craniotomy was considered as realistic by 89% and 94% of users respectively. Most participants agreed that this simulator should be integrated in neurosurgical education (94%). Our illustrative cases demonstrated that virtual aneurysm surgery was possible using the same trajectory as in real-life cases. Both, virtual clipping and blood flow simulation were realistic in broad based but not calcified aneurysms. Virtual clipping of a calcified aneurysm could be performed using the same surgical trajectory but not the same clip type.
CONCLUSION: We have successfully developed a virtual aneurysm-clipping simulator and will now prospectively evaluate this device for surgical procedure planning and education.

PMID: 29337170 [PubMed - as supplied by publisher]

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