Operative planning and training for microsurgical clipping of intracranial aneurysm in a stereoscopic virtual reality environment

Objective: Microsurgical clipping of intracranial aneurysm is a crucial part of vascular neurosurgery. With the advent of endovascular embolization, the microsurgical clipping cases are usually aneurysms that are not suitable for embolization, at times complex and difficult. We devised an innovative application of pre-operative planning and rehearsal for microsurgical clipping of intracranial aneurysm in a stereoscopic virtual reality environment. Method: DICOM data of patient-specific computed tomography of skull bone and computed tomographic angiography of intracranial circulation were loaded into the workstation (Dextroscope, Volume Interactions Pte Ltd). An aneurysm clip database was also loaded into the patient data set. 3D volume rendering was followed by data co-registration and fusion. Result: Ten patient data were managed as above. Virtual head positioning and craniotomy were carried out to stimulate the microscopic visualization. Clip selection could be carried out with reference to the angle of application available. Conclusion: The virtual microsurgical clipping application enhanced the understanding the anatomy and simulated the operative environment encountered in microsurgical clipping.