Neurosurgery

Project leaders : Christian Duriez, Laurent Thinès
Engineer : Eulalie Coevoet

Training in cerebrovascular surgery, and particularly in the microsurgical treatment of intracranial aneurysms, is nowadays a concern of many neurosurgery residency programs all over the world. Due to the development of endovascular procedures those past twenty years, we observe a drastic reduction in operated cases. Simulation could be a promising option for training and maintaining the high level of expertise that is expected. Therefore, we developed a simulator prototype reproducing the microsurgical approach and the intracranial aneurysms clipping.

The following videos show the four pedagogic scenarios we developed (from top to bottom): sylvian fissure opening, aneurysm exposure, aneurysm clipping and aneurysm rupture management.

Sylvian fissure opening: The user performs the sylvian fissure opening. It consistes in cutting the arachnoidal strands that connect the frontal lobe to the temporal lobe, with the dissecting tool in his right hand. A second tool (suction tool) in his left hand can help the process. All scenarios train the user to bimanual manipulation which is crucial in microsurgery and not instinctive. The tools are controlled with haptic devices (Phantom Omni).


Aneurysm exposure
: The sylvian fissure opening done, with use two brain retractors to simulate spreaded frontal and temporal lobes. The user now perfoms the aneurysm exposure.


Aneurysm clipping
: After selecting the appropriate clip, the user performs the aneurysm clipping. The clip can be grabbed and dropped.


Aneurysm rupture management
: One can simulate a rupture zone on the anerysm. When touched involuntary, a bleeding occurred and forced the user to react quickly. The goal is now to see the vessels again by using the suction tool, and stop the bleeding by performing a temporary clamp. The clamp set, the blood stop and the user has around five minutes to perform the clipping and remove the clamp.

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