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67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

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Advantages of virtual clip preselection in aneurysm-surgery

Meeting Abstract

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  • Eike Schwandt - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany
  • Ralf Kockro - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany; Neurochirurgie Hirslanden, Klinik Hirslanden, Zürich, Switzerland
  • Andreas Kramer - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany
  • Ali Ayyad - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany
  • Martin Glaser - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany
  • Alf Giese - Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocP 003

doi: 10.3205/16dgnc378, urn:nbn:de:0183-16dgnc3788

Published: June 8, 2016

© 2016 Schwandt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To optimize surgical aneurysm occlusion we used a 3D-virtual-reality planning device (Dextroscope) to selected matching clips prior to the operation. To evaluate potential benefits we compared the postoperative results and the clinical outcome of elective aneurysm-surgery with preselected clip (n=19 aneurysms) and without (n=64 aneurysms).

Method: 0,5mm sliced CTA-scan or 1mm sliced MRI-scan of the neurocranium and an aneurysm clip (Fa Peter Lazic GmbH, Germany) database were uploaded into the dextroscope-3D-planning-station (Volume Interactions Ltd., Singapore). The dextroscope software allowed the surgeon to choose the most suitable clip for aneurysm size, shape and approach in virtual reality. Postoperatively the clipping-result was evaluated by angiography prospecting for remnants. Clinical outcome was rated using modified Rankin Scale (mRS).

Results: In procedures, in which the aneurysm was occluded with a preselected clip, complete closure was accomplished in 94,73% (n=19 aneurysms, 44,4% SAH), in the control-group in 87,5% (n=64 Aneurysms, 17,5% SAH). No mortality occurred in both groups. Good outcome (mRS ≤2 at 6 month) was achieved in the preselection group 100%, control-group 92,9%.

Conclusions: The preoperative selection and simulation of an optimal clip improved the the result of aneurysm surgery regarding the completeness of closure of the aneurysm and the postoperative morbidity-rate. Compared with ISUIA- (Wiebers 2003) and BRAT-study (Spetzler 2015) the occlusion rate and outcome are improved in this study.