Document Detail


Simulation of and training for cerebral aneurysm clipping with 3-dimensional models.
MedLine Citation:
PMID:  19834377     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: With improvements in endovascular techniques, fewer aneurysms are treated by surgical clipping, and those aneurysms targeted for open surgery are often complex and difficult to treat. We devised a hollow, 3-dimensional (3D) model of individual cerebral aneurysms for preoperative simulation and surgical training. The methods and initial experience with this model system are presented. METHODS: The 3D hollow aneurysm models of 3 retrospective and 8 prospective cases were made with a prototyping technique according to data from 3D computed tomographic angiograms of each patient. Commercially available titanium clips used in our routine surgery were applied, and the internal lumen was observed with an endoscope to confirm the patency of parent vessels. The actual surgery was performed later. RESULTS: In the 8 prospective cases, the clips were applied during surgery in the same direction and configuration as in the preoperative simulation. Fine adjustments were necessary in each case, and 2 patients needed additional clips to occlude the atherosclerotic aneurysmal wall. With these 3D models, it was easy for neurosurgical trainees to grasp the vascular configuration and the concept of neck occlusion. Practicing surgery with these models also improved their handling of the instruments used during aneurysm surgery, such as clips and appliers. CONCLUSION: Using the hollow 3D models to simulate clipping preoperatively, we could treat the aneurysms confidently during live surgery. These models allow easy and concrete recognition of the 3D configuration of aneurysms and parent vessels.
Authors:
Toshikazu Kimura; Akio Morita; Kengo Nishimura; Hitoshi Aiyama; Hirotaka Itoh; Syunsuke Fukaya; Shigeo Sora; Chikayuki Ochiai
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  65     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-16     Completed Date:  2010-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  719-25; discussion 725-6     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Kanto Medical Center, NTT EC, Tokyo, Japan.
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MeSH Terms
Descriptor/Qualifier:
Cerebral Angiography / methods
Cerebral Arteries / pathology*,  surgery*
Computer-Aided Design
Education, Medical, Graduate / methods
Female
Humans
Imaging, Three-Dimensional / methods
Intracranial Aneurysm / pathology*,  radiography,  surgery*
Middle Aged
Models, Anatomic*
Neurosurgical Procedures / education,  instrumentation,  methods
Polymers / diagnostic use
Prospective Studies
Retrospective Studies
Surgical Instruments
Teaching
Tomography, X-Ray Computed / methods
Treatment Outcome
Vascular Surgical Procedures / education*,  instrumentation,  methods
Chemical
Reg. No./Substance:
0/Polymers

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