gms | German Medical Science

Objective: In this case we saw a 59 year old female patient with a complex aneurysm of the middle cerebral artery bifurcation in our outpatient clinic. We decided to build a 3-dimensional model for surgical planning. The goal was to evaluate which clips should be used in which order to carefully plan our surgical strategy.

Methods: The patient underwent routine diagnostic procedures which were, digital subtraction rotational angiography and an MRI scan. We used the DICOM files from the MRI scan and open source software to build a 3-dimensional model of the main vessels including the vessels surrounding the aneurysm. The model was then printed within 24hours using a 3D printer.

Results: We were able to choose all 3 clips which we finally used pre-op. It proved that it was very helpful to choose the clips before surgery, because one of the difficulties in this aneurysm was that 2 clips where located very close together. As a result we used a special bent clip, which we had to order to solve this problem. Due to our pre-op planning the surgery for this complex aneurysm went without any complications. Intraoperativ angiography with Indocyanine green and intraoperative microvascular Doppler sonography showed complete occlusion of the aneurysm with no stenosis of the vessels. The patient was discharged 7 days after surgery without any clinical symptoms. Control imaging after 3 months showed complete occlusion without reoccurrence.

Conclusion: The model fitted the patients anatomy exactly. We could choose the clips and the clipping strategy before surgery. The planning was very helpful for the surgical team in the operation room and helped to make this operation very save and successful. In further studies we want to improve on this tool, and make it available for more clinics as a fast, easy and affordable tool.