gms | German Medical Science

Objective: Anterior communicating artery (ACoA) aneurysms are known to have diverse configurations, vascular relationships, and anatomical variations. Evaluation and operative treatment of these aneurysms necessitate perfect surgical strategy based on review of three-dimensional (3D) angioarchitecture using several radiologic cranial imaging methods. We retrospectively analyzed the potential influence of 3D virtual reality (VR) reconstructions compared to conventional computed tomography angiography (CTA) scans on the identification of vascular anatomy and neighboring structures, and on the surgical planning in patients with unruptured ACoA aneurysms.

Methods: Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative CTA scans were retrospectively reconstructed to 3D-VR images and visualized via VR software to detect the characteristics of unruptured ACoA aneurysms. A questionnaire of experienced neurosurgeons evaluated the influence of VR visualization technique on identification of aneurysm morphology and relevant arterial anatomy and on surgical strategy.

Results: Twenty-six patients were included and 520 answer sheets were evaluated. Image presentation using 3D-VR modality significantly influenced the detection of the aneurysm-related vascular structures (p = 0.0001), as well as the recommended head positioning (p = 0.005) and surgical approach (p = 0.001) in the planning of microsurgical clipping.

Conclusion: In patients with unruptured ACoA aneurysms, the reconstruction of conventional preoperative CTA scans into 3D images and the spatial and anatomical presentation in VR models enable greater understanding of the anatomy and pathology, provide realistic haptic feedback for aneurysm surgery, and thus influence operation planning and strategy.