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Related Experiment Video

Updated: Mar 5, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Tool-Tissue Interaction Forces in Brain Arteriovenous Malformation Surgery.

Taku Sugiyama1, Liu Shi Gan2, Kourosh Zareinia2

  • 1Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary, Calgary AB, Canada; Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.

World Neurosurgery
|March 25, 2017
PubMed
Summary

Applying excessive force during brain arteriovenous malformation (AVM) surgery can injure delicate vessels. Force-sensing instruments can detect and predict these injuries, aiding surgical training and performance.

Keywords:
Arteriovenous malformationBipolar forcepsEducationForceTool–tissue interaction

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Area of Science:

  • Neurosurgery
  • Biomedical Engineering
  • Surgical Instrumentation

Background:

  • Surgical resection of brain arteriovenous malformations (AVMs) is challenging due to fragile vessels.
  • Optimizing applied force is crucial for surgical success and training.

Purpose of the Study:

  • To develop and evaluate a force-sensing bipolar forceps for AVM surgery.
  • To establish a quantifiable metric for detecting and predicting vessel injury during AVM resection.

Main Methods:

  • A force-sensing bipolar forceps was engineered using strain gauge sensors.
  • Force data from 519 surgical trials in 2 AVM surgeries were collected and analyzed.
  • Receiver operating curve analysis identified optimal force thresholds and assessed discriminative accuracy.

Main Results:

  • Unsuccessful trials (3.1%) showed significantly higher mean (0.33 N vs 0.23 N) and maximum forces (0.53 N vs 0.35 N) compared to successful trials (P < 0.001).
  • Area under the curve values of 0.91 for mean force and 0.87 for maximum force indicated strong prediction of unsuccessful trials.
  • Increased surgical time correlated with a higher rate of unsuccessful trials and error forces.

Conclusions:

  • Excessive tool-tip force is a key factor in fragile vessel injury during AVM surgery.
  • Force-sensing technology provides a quantifiable metric to detect and predict surgical injuries.
  • This instrument holds potential for resident training and performance evaluation in AVM surgery.