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How I do it? Preoperative Microsoft HoloLens 2 planning-assisted surgical clipping of a fetal posterior cerebral artery aneurysm

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Abstract

Background

The treatment of intracranial aneurysms has predominantly shifted towards endovascular strategies, but complex cases still necessitate microsurgery. Preoperative stimulation can be beneficial for inexperienced young neurosurgeons in preparing for safe microsurgery.

Method

A 72-year-old female with a left irregular fetal posterior cerebral artery (PCA) aneurysm underwent clipping repair. Microsoft HoloLens 2, utilizing mixed reality technology, was employed for preoperative stimulation and anatomical study. During the operation, we successfully identified the planned relationship between the aneurysm and the fetal PCA. The patient was cured without any complications.

Conclusion

We hope that this report will highlight the significance of Microsoft HoloLens 2 in microsurgical planning and education.

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References

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Funding

This study was sponsored by the Shanghai Municipal Alliance for Clinical Competence Improvement and Advancement in Neurosurgery (SHDC22021303), the Fujian Province Science and Technology Innovation Joint Fund (No. 2021Y9135), and the Pudong New Area Science and Technology Development Fund (No. PKX2020-R03).

Author information

Author notes

  1. Xiaorong Yan, Zhiyi Yuan, and Zixiao Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China

    Xiaorong Yan

  2. Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China

    Xiaorong Yan

  3. School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China

    Zhiyi Yuan

  4. Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  5. Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China

    Zixiao Yang & Jianping Song

  6. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  7. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  8. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China

    Zixiao Yang & Jianping Song

  9. Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China

    Jianping Song

Authors
  1. Xiaorong Yan
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  2. Zhiyi Yuan
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  3. Zixiao Yang
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  4. Jianping Song
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Contributions

Xiaorong Yan, MD, PhD: Original draft, data collecting, writing—review and editing. Zhiyi Yuan, M.Eng: Conceptualization, writing—review and editing.

Zixiao Yang, MD, PhD: Data collecting, writing—review and editing.

Jianping Song, MD, PhD: Conceptualization, supervision, writing—review and editing, project administration.

Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.

Consent to participate

Informed consent was obtained from the patient included in the study.

Consent for publication

It represents a video of a surgical case. The patient gave approval for this publication.

Competing interests

The authors declare no competing interests.

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Publisher's Note

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Key points

1. Complex intracranial aneurysms that may not be safely treated with endovascular procedures still require microsurgical treatment.

2. The fetal PCA directly supplies the occipital lobe from anterior circulation, resulting in vascular insufficiency if occluded.

3. Microsurgical expertise remains necessary in developing countries where the cost of endovascular technologies is prohibitive.

4. In the case of a wide-neck fetal PCA aneurysm, endovascular coiling may have a higher risk of recurrence, and stenting may pose a risk of fetal PCA occlusion, making microsurgical clipping a preferred option.

5. Mixed reality technology may help simulate the surgical procedure and anatomy and teach surgical nuances.

6. Patients should be informed about the risks of intraoperative rupture, injury to the fetal PCA, and potential impairment to the oculomotor nerve.

7. Transcranial electrophysiological monitoring and ICGVA are essential adjunct tools during intracranial aneurysm microsurgery.

8. Extreme care must be taken not to occlude the proximal fetal PCA during aneurysm repair.

9. The irregular shape of the aneurysm may indicate adherence to the tentorium, requiring precise and fast clipping to avoid tearing the dome of the aneurysmal sac.

10. Intraoperative imaging and follow-up are necessary to confirm the aneurysm’s total occlusion and the fetal PCA’s patency.

Supplementary Information

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Supplementary file1 (52.7 MB)

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Yan, X., Yuan, Z., Yang, Z. et al. How I do it? Preoperative Microsoft HoloLens 2 planning-assisted surgical clipping of a fetal posterior cerebral artery aneurysm. Acta Neurochir 165, 3371–3374 (2023). https://doi.org/10.1007/s00701-023-05810-4

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  • DOI: https://doi.org/10.1007/s00701-023-05810-4

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