Endovascular Treatment of Cerebral Aneurysms Using Preoperative Simulation

Abstract

In recent years, the integration of high-resolution medical imaging with computational fluid dynamics (CFD) and computational structural mechanics (CSM) has allowed for the clinical application of various preoperative simulation techniques. This has enhanced the precision and efficacy of neurosurgical procedures. For coil embolization procedures, these advancements not only help to determine the ideal microcatheter position and coil selection but also enable the simulation of stent-assisted coil embolization. This includes the selection of stent size and deployment location. Similarly, for flow-diverter stent placement, these techniques allow the prediction of postimplantation elongation and contraction specific to braided stents, therefore enabling the development of highly accurate treatment strategies. Furthermore, using three-dimensional (3D) printing models for simulation has proven valuable in tailoring preoperative simulations and hands-on training for procedures involving intracranial stents and the Woven EndoBridge device. These simulation technologies may help to predict aneurysm rupture and guide retreatment decisions, as well as enable treatment planning program design through integration with artificial intelligence. The continued use of CFD, CSM, and 3D printing technologies in fields such as device training and treatment outcome prediction is expected to evolve and synergy between medicine and engineering is pivotal in this process. However, regulatory approval and appropriate commercialization strategies for software programs and 3D printers face challenges that must be addressed soon to fully harness the potential of innovative technologies for clinical practice and patient care.