Microsurgical clipping of middle cerebral artery aneurysms: preoperative planning using virtual reality to reduce procedure time

Abstract

OBJECTIVE The authors sought to evaluate the impact of virtual reality (VR) applications for preoperative planning and rehearsal on the total procedure time of microsurgical clipping of middle cerebral artery (MCA) ruptured and unruptured aneurysms compared with standard surgical planning. METHODS A retrospective review of 21 patients from 2016 to 2019 was conducted to determine the impact on the procedure time of MCA aneurysm clipping after implementing VR for preoperative planning and rehearsal. The control group consisted of patients whose procedures were planned with standard CTA and DSA scans (n = 11). The VR group consisted of patients whose procedures were planned with a patient-specific 360° VR (360VR) model (n = 10). The 360VR model was rendered using CTA and DSA data when available. Each patient was analyzed and scored with a case complexity (CC) 5-point grading scale accounting for aneurysm size, incorporation of M2 branches, and aspect ratio, with 1 being the least complex and 5 being the most complex. The mean procedure times were compared between the VR group and the control group, as were the mean CC score between the groups. Comorbidities and aneurysm conduction (ruptured vs unruptured) were also taken into consideration for the comparison. RESULTS The mean CC scores for the control group and VR group were 2.45 ± 1.13 and 2.30 ± 0.48, respectively. CC was not significantly different between the two groups (p = 0.69). The mean procedure time was significantly lower for the VR group compared with the control group (247.80 minutes vs 328.27 minutes; p = 0.0115), particularly for the patients with a CC score of 2 (95% CI, p = 0.0064). A Charlson Comorbidity Index score was also calculated for each group, but no statistical significance was found (VR group, 2.8 vs control group, 1.8, p = 0.14). CONCLUSIONS In this study, usage of 360VR models for planning the craniotomy and rehearsing with various clip sizes and configurations resulted in an 80-minute decrease in procedure time. These findings have suggested the potential of VR technology in improving surgical efficiency for aneurysm clipping procedures regardless of complexity, while making the procedure faster and safer.