Augmented Reality in the Surgery of Cerebral Aneurysms: A Technical Report

2014 ◽  
Vol 10 (2) ◽  
pp. 252-261 ◽  
Author(s):  
Ivan Cabrilo ◽  
Philippe Bijlenga ◽  
Karl Schaller
Keyword(s):  
Augmented Reality ◽  
Technological Development ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Image Data ◽  
Surgical Approaches ◽  
User Friendliness ◽  
Invasive Approach ◽  
Unruptured Aneurysms ◽  
3 Dimensional

Abstract BACKGROUND: Augmented reality is the overlay of computer-generated images on real-world structures. It has previously been used for image guidance during surgical procedures, but it has never been used in the surgery of cerebral aneurysms. OBJECTIVE: To report our experience of cerebral aneurysm surgery aided by augmented reality. METHODS: Twenty-eight patients with 39 unruptured aneurysms were operated on in a prospective manner with augmented reality. Preoperative 3-dimensional image data sets (angio-magnetic resonance imaging, angio-computed tomography, and 3-dimensional digital subtraction angiography) were used to create virtual segmentations of patients' vessels, aneurysms, aneurysm necks, skulls, and heads. These images were injected intraoperatively into the eyepiece of the operating microscope. An example case of an unruptured posterior communicating artery aneurysm clipping is illustrated in a video. RESULTS: The described operating procedure allowed continuous monitoring of the accuracy of patient registration with neuronavigation data and assisted in the performance of tailored surgical approaches and optimal clipping with minimized exposition. CONCLUSION: Augmented reality may add to the performance of a minimally invasive approach, although further studies need to be performed to evaluate whether certain groups of aneurysms are more likely to benefit from it. Further technological development is required to improve its user friendliness.

scholarly journals @neurIST complex information processing toolchain for the integrated management of cerebral aneurysms

2011 ◽  
Vol 1 (3) ◽  
pp. 308-319 ◽  
Author(s):  
M. C. Villa-Uriol ◽  
G. Berti ◽  
D. R. Hose ◽  
A. Marzo ◽  
A. Chiarini ◽  
...  
Keyword(s):  
Integrated Management ◽  
Cerebral Aneurysms ◽  
Image Data ◽  
Aneurysm Rupture ◽  
Wall Structure ◽  
Data Provenance ◽  
Unruptured Aneurysms ◽  
Related Data ◽  
Aneurysm Wall ◽  
Human Operators

Cerebral aneurysms are a multi-factorial disease with severe consequences. A core part of the European project @neurIST was the physical characterization of aneurysms to find candidate risk factors associated with aneurysm rupture. The project investigated measures based on morphological, haemodynamic and aneurysm wall structure analyses for more than 300 cases of ruptured and unruptured aneurysms, extracting descriptors suitable for statistical studies. This paper deals with the unique challenges associated with this task, and the implemented solutions. The consistency of results required by the subsequent statistical analyses, given the heterogeneous image data sources and multiple human operators, was met by a highly automated toolchain combined with training. A testimonial of the successful automation is the positive evaluation of the toolchain by over 260 clinicians during various hands-on workshops. The specification of the analyses required thorough investigations of modelling and processing choices, discussed in a detailed analysis protocol. Finally, an abstract data model governing the management of the simulation-related data provides a framework for data provenance and supports future use of data and toolchain. This is achieved by enabling the easy modification of the modelling approaches and solution details through abstract problem descriptions, removing the need of repetition of manual processing work.

Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: endovascular therapies favored over surgery

2020 ◽  
Vol 12 (10) ◽  
pp. 957-963 ◽  
Author(s):  
Alice S Wang ◽  
Jessica K Campos ◽  
Geoffrey P Colby ◽  
Alexander L Coon ◽  
Li-Mei Lin
Keyword(s):  
Cerebral Aneurysms ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
National Inpatient Sample ◽  
Hospital Discharges ◽  
Unruptured Aneurysms ◽  
Treatment Practice ◽  
Aneurysm Treatment ◽  
Significant Difference ◽  
The Usa

BackgroundFlow modulation is the newest endovascular technique for treatment of cerebral aneurysms.ObjectiveTo investigate changes in aneurysm treatment practice patterns in the USA.MethodsFrom the 2007 to 2016, the National Inpatient Sample databases, hospital discharges associated with unruptured aneurysms (UA), and/or ruptured aneurysms (RA) having undergone surgical clipping (SC) and/or endovascular treatments (EVT) were identified using the International Classification of Diseases codes. Patient demographics, hospital characteristics, and clinical outcomes were reviewed. Five year subgroup analyses were performed for treatment differences.ResultsA total of 39 282 hospital discharges were identified with a significant increase in EVT (UA: SC n=7847 vs EVT n=12 797, p<0.001; RA: SC n=8108 vs EVT n=10 530, p<0.001). Hospitals in the South demonstrated the most significant EVT use regardless of aneurysm status (UA: SC n=258.5±53.6 vs EVT n=480.7±155.8, p<0.001; RA: SC n=285.6±54.3 vs EVT n=393.3±102.9, p=0.003). From 2007 to 2011, there was no significant difference in the mean number of cases for the treatment modalities (UA: SC n=847.4±107.7 vs EVT n=1120.4±254.1, p=0.21; RA: SC n=949.4±52.8 vs EVT n=1054.4±219.6, p=0.85). Comparatively, from 2012 to 2016, significantly more UA and RA were treated endovascularly (UA: SC n=722.0±43.4 vs EVT n=1439.0±419.2, p<0.001; RA: SC n=672.2±61.4 vs EVT n=1051.6±330.2, p=0.02).ConclusionsAs technological innovations continue to advance the neuroendovascular space, the standard of care for treatment of cerebral aneurysms is shifting further towards endovascular therapies over open surgical approaches in the USA.

Cyanosis and Clipping: Noninfectious Aneurysm in a Patient with 22q11.2 Deletion Syndrome

2021 ◽  
pp. 1-5
Author(s):  
Bhanu Jayanand Sudhir ◽  
Sanjay Honavalli Murali ◽  
Jaypalsinh Gohil ◽  
Rajalakshmi Poyuran ◽  
Manikantan Sethuraman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
22Q11.2 Deletion Syndrome ◽  
Neurological Deficits ◽  
Deletion Syndrome ◽  
Anterior Communicating Artery ◽  
Cyanotic Heart Disease ◽  
22Q11.2 Deletion ◽  
Congenital Cyanotic Heart Disease

Noninfectious cerebral aneurysms are rare in patients with congenital cyanotic heart disease. We present a patient with DiGeorge/velocardiofacial syndrome with a complex congenital cyanotic heart disease with a ruptured anterior communicating artery aneurysm. The 10-year-old child was managed by surgical clipping of the aneurysm. Surgical challenges included prominent veins in the Sylvian fissure, difficulty in differentiating arterial and venous bleed, and anesthetic risks. The patient recovered without any neurological deficits. This is the first report of a patient with 22q11.2 deletion syndrome, with a noninfectious cerebral aneurysm.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

scholarly journals Augmented reality visualisation for orthopaedic surgical guidance with pre‐ and intra‐operative multimodal image data fusion

2018 ◽  
Vol 5 (5) ◽  
pp. 189-193 ◽  
Author(s):  
Houssam El‐Hariri ◽  
Prashant Pandey ◽  
Antony J. Hodgson ◽  
Rafeef Garbi
Keyword(s):  
Augmented Reality ◽  
Data Fusion ◽  
Image Data ◽  
Surgical Guidance

Abstract 1122‐000145: Impact of Age on Outcomes Following Endovascular vs Clipping of Ruptured and Unruptured Cerebral Aneurysms

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Hamidreza Saber ◽  
Naoki Kaneko ◽  
David Kimball ◽  
Jose Morales ◽  
Satoshi Tateshima ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Endovascular Therapy ◽  
Age Groups ◽  
Cerebral Aneurysms ◽  
Unruptured Aneurysm ◽  
Favorable Outcome ◽  
Hospital Length Of Stay ◽  
Surgical Clipping ◽  
Unruptured Aneurysms ◽  
Unruptured Cerebral Aneurysms

Introduction : Age is an important determinant of outcome in patients with unruptured or ruptured cerebral aneurysms. Advancements in endovascular therapies have significantly impacted patient selection and treatment of patients with cerebral aneurysm. Recent release of the National claims data for 2017–2018 provides the opportunity to explore novel population‐level outcomes following clipping vs endovascular treatment of ruptured and unruptured cerebral aneurysms in different age groups. Methods : Analysis of US National Inpatient Sample of hospitalizations with aneurysmal subarachnoid hemorrhage (aSAH) or unruptured aneurysms treated with clipping or endovascular therapy from January 1, 2017 to December 31, 2018. Pre‐defined age strata included: younger than 50 years; 50–64 years; 65–79 years; and 80 years or older. Primary outcomes included in‐hospital mortality and favorable outcome defined as discharge to home. Results : Overall, 34,955 hospitalizations with unruptured aneurysm treatment, (26,695 endovascular and 8,260 surgical clipping), and 17,525 hospitalizations with aSAH were identified in the study period. In unruptured aneurysm group, endovascular therapy was associated with significantly higher favorable outcome across all age groups, and lower mortality in those 65 years or older (all P<0.001) when compared to clipping. Median hospital length‐of‐stay was 1 day (IQR 1–4) in endovascular vs 4 days (IQR 3–8) in clipping group (P<0.001). In aSAH group, endovascular therapy was associated with higher favorable outcome in 50–80 years age groups when compared to clipping, with no significant differences for in‐hospital mortality outcome (Table). Significantly more favorable outcomes were achieved with coiling vs clipping in those aged 65 or above with unruptured aneurysms. Conclusions : In 2017–2018 in US, unruptured aneurysm patients treated with endovascular therapy had significantly lower morbidity and mortality compared to those treated with surgical clipping, and differences were more pronounced with age. Similar but less strong association was observed in patients with aSAH.

Heterogeneity and neurovascular integration of intraportally transplanted islets revealed by 3-D mouse liver histology

2021 ◽  
Author(s):  
Chien-Chia Chen ◽  
Shih-Jung Peng ◽  
Pei-Yu Wu ◽  
Hung-Jen Chien ◽  
Chih-Yuan Lee ◽  
...  
Keyword(s):  
Islet Transplantation ◽  
Mouse Liver ◽  
Image Data ◽  
Liver Histology ◽  
Systematic Assessment ◽  
3 Dimensional ◽  
Neural Integration ◽  
Quantitative Analyses ◽  
Graft Tissue

Background: Intraportal islet transplantation has been clinically applied for treatment of unstable type 1 diabetes. However, in the liver, systematic assessment of the dispersed islet grafts and the graft-hepatic integration remains difficult, even in animal models. This is due to the lack of global and in-depth analyses of the transplanted islets and their microenvironment. Here, we apply 3-dimensional (3-D) mouse liver histology to investigate the islet graft microstructure, vasculature, and innervation. Methods: Streptozotocin-induced diabetic mice were used in syngeneic intraportal islet transplantation to achieve euglycemia. Optically cleared livers were prepared to enable 3-D morphological and quantitative analyses of the engrafted islets. Results: 3-D image data reveal the clot- and plaque-like islet grafts in the liver: the former are derived from islet emboli and associated with ischemia, whereas the latter (minority) resemble the plaques on the walls of portal vessels (e.g., at the bifurcation) with mild, if any, peri-graft tissue damage. Three weeks after transplantation, both types of grafts are revascularized, yet significantly more lymphatics are associated with the plaque- than clot-like grafts. Regarding the islet reinnervation, both types of grafts connect to the peri-portal nerve plexus and develop peri- and intra-graft innervation. Specifically, the sympathetic axons and varicosities contact the α-cells, highlighting the graft-host neural integration. Conclusion/interpretation: We present the heterogeneity of the intraportally transplanted islets and the graft-host neurovascular integration in mice. Our work provides the technical and morphological foundation for future high-definitional 3-D tissue and cellular analyses of human islet grafts in the liver.

scholarly journals Laparoscopic resection of bilateral perinephric pseudocyst in a pediatric feline patient

2019 ◽  
Vol 5 (1) ◽  
pp. 205511691985064
Author(s):  
Margaret Amparo Placer ◽  
Cindy McManis
Keyword(s):  
Laparoscopic Resection ◽  
Kidney Injury ◽  
Abdominal Distension ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Invasive Approach ◽  
Less Invasive Approach ◽  
History Of ◽  
Grade 3

Case summary A 6-month-old male domestic shorthair cat presenting with abdominal distension and an acute history of renal azotemia was diagnosed with bilateral perinephric pseudocysts and International Renal Interest Society (IRIS) grade 3 acute kidney injury. Ultrasound-guided drainage of the cysts was performed initially; bilateral subtotal resection of the perinephric pseudocysts was later performed using laparoscopy as a more long-term solution. There was no regrowth or reformation of the perinephric pseudocysts 1 year after the procedure, and the cat remained in IRIS stage 2 chronic kidney disease 1 year postoperatively. Relevance and novel information Compared with traditional surgical approaches, laparoscopic resection of perinephric pseudocysts provides a less invasive approach. Bilateral perinephric pseudocyst in a pediatric feline patient (and associated treatment) has not previously been documented in the literature.

scholarly journals Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

2015 ◽  
Vol 21 (6) ◽  
pp. 654-658 ◽  
Author(s):  
Peng Liu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Ming Lv
Keyword(s):  
Cesarean Section ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Healthy Baby ◽  
Unruptured Aneurysms ◽  
Gestational Week ◽  
Basilar Tip Aneurysm ◽  
Case Basis

We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.

Surgery for angiographically occult cerebral aneurysms

1993 ◽  
Vol 79 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Jafar J. Jafar ◽  
Howard L. Weiner
Keyword(s):  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Ct Scans ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Interpeduncular Cistern ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Exploratory Surgery

✓ In 15% of patients with spontaneous subarachnoid hemorrhage (SAH), the source of bleeding cannot be determined despite repeated cerebral angiography. However, some patients diagnosed as having “SAH of unknown cause” actually harbor undetected aneurysms. The authors report six patients with SAH who, despite multiple negative cerebral angiograms, underwent exploratory surgery due to a high clinical and radiographic suspicion for the presence of an aneurysm. Brain computerized tomography (CT) scans revealed blood located mainly in the basal frontal interhemispheric fissure in four patients, in the sylvian fissure in one patient, and in the interpeduncular cistern in one patient. The patients were evaluated as Hunt and Hess Grades I to III, and had undergone at least two high-quality cerebral angiograms that did not reveal an aneurysm. Vasospasm was visualized in two patients. Three patients rebled while in the hospital. Exploratory surgery was performed at an average of 12 days post-SAH. Five aneurysms were discovered at surgery and were successfully clipped. All four patients with interhemispheric blood were found to have an anterior communicating artery (ACoA) aneurysm. The patient with blood in the sylvian fissure was found to have a middle cerebral artery aneurysm. These aneurysms were partially thrombosed. No aneurysm was detected in the patient with interpeduncular SAH, despite extensive basilar artery exploration. Five patients had an excellent outcome and one patient developed diabetes insipidus. These results show that exploratory aneurysm surgery is warranted, despite repeated negative cerebral angiograms, if the patient manifests the classical signs of SAH with CT scans localizing blood to a specific cerebral blood vessel (particularly the ACoA) and if a second SAH is documented at the same site.

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